Departure Form

This form is for Binghamton University international students and J scholars and faculty who are leaving the university and will not be enrolled in the next semester.

Federal SEVIS regulations require F and J students, scholars and faculty to notify the ISSS when you are ending your studies or program. Reasons for leaving include graduation, completion of program, termination of studies, withdrawal, leave of absence or transfer.

DEPARTURE INFORMATION

Select one:
I am a
    Current F or J Student
    Former F or J Student
    J Scholar or Faculty

Last Name:

First Name:

Middle Name:

Field of study:

Degree (if applicable):

Graduation Date (if applicable):

(mm/dd/yy)

Citizenship:

Email Address

Please answer the following questions as they pertain to you:

I plan to leave for my home country

Forwarding Address:

Address1:

Address2:

City:

Province/State:

Country:

Postal Code:

Date of departure: (mm/dd/yy)

I have applied for practical training

New Address Information:

Address1:

Address2:

City:

Province/State:

Country:

Postal Code:

I am transferring to another university.

You must complete a SEVIS release form with the ISSS so that your SEVIS record can be transferred to your new school

Name of school transferring to:

School Address:

Address1:

Address2:

City:

Province/State:

Country:

Postal Code:

Other (leave of absence, illness, family emergency, withdrawal, etc)

Other reason:

Forwarding Address:

Address1:

Address2:

City:

Province/State:

Country:

Postal Code:

Date of departure: (mm/dd/yy)