NYU Summer Programs Overnight & Weekend Leave Request Form
Residential students are not allowed to be away overnight or on weekends. Absence from their program can negatively impact a student’s experience. In the case of extenuating circumstances or emergencies, the parent/guardian on record for the student may submit this form. Requests must come from parents/guardians; requests received from students will be denied.

REQUESTS MUST BE SUBMITTED AT LEAST 48 HOURS IN ADVANCE OF THE LEAVE AND NO LATER THAN 12:00 PM ON FRIDAYS FOR LEAVES DURING THE WEEKEND.

Once the form is received and processed, the student will receive an email confirming permission to leave.

NOTE: Students cannot leave campus before 7:00 AM on the day of departure, and they must return to their residence hall by curfew on the day of their return (11:00 PM Sunday-Thursday, 12:00 AM Friday-Saturday). The overnight leave request form is not intended as a means to stay out after curfew, and students cannot be on the NYU campus while on leave.
Email address *
STUDENT INFORMATION
Student's Last Name *
Your answer
Student's First Name *
Your answer
Student's Email Address *
Your answer
Student's Cell Phone Number *
Please use numbers only. No parentheses or dashes, please.
Your answer
Student's Summer Program *
Student's Residential Hall *
Room Number *
Your answer
OVERNIGHT LEAVE INFORMATION
Date of Departure *
MM
/
DD
/
YYYY
Time of Departure (students cannot leave before 7:00AM) *
Time
:
Date of Return *
MM
/
DD
/
YYYY
Time of Return (students must return before curfew) *
Time
:
Name of Overnight Host *
Your answer
Host's Relation to Student *
Your answer
Overnight Phone Number *
Please use numbers only. No parentheses or dashes, please.
Your answer
Overnight Address *
Your answer
Reason for Leaving Campus *
Your answer
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name (First and Last) *
Your answer
Parent/Guardian's Email Address *
Your answer
Parent/Guardian's Cell Phone Number *
Please use numbers only. No parentheses or dashes, please.
Your answer
Parent/Guardian's Home Phone Number
Please use numbers only. No parentheses or dashes, please.
Your answer
PARENT/GUARDIAN AUTHORIZATION
By checking below, I acknowledge I am giving permission for my student to leave their NYU program and the NYU campus for the duration of the leave. *
Required
By entering my name below, I confirm that I am the parent/guardian of the student listed on this form and understand the below serves as my e-signature. *
Your answer
A copy of your responses will be emailed to the address you provided.
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