Please complete the information below, add your name and return to the Dean's office (Nollen 2) before break. If you will be leaving Grinnell for the break, please indicate an address and phone number where you can be reached during this time. Our office receives a number of inquiries from students and others during this period, and it's very helpful to have this information.

Thank you - and enjoy your break!

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NAME: _________________

___ No, I won't be leaving Grinnell during winter break.

___ Yes, I will be leaving Grinnell during winter break.

Date leaving: _______________

Date returning: ______________

I can be reached at the following address: (please include a phone number)