Imagery of Regent people and campus

International Travel Assistance Fee

Please submit this form to pay the $50 international travel assistance fee.

About You

First Name:
Last Name:
School/Department:
Phone Number:
Email:
Address:
City:
State/Province:
Country:
Zip/Postal Code:

About Your Trip

Country:
Start Date: (MM/DD/YYYY)
End Date: (MM/DD/YYYY)
Title:
Description:
200 characters left