Departure Form


* indicates that the field is required

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
Date: 11/26/2014
Select One:
* I am a


 
B-Number *Date of Birth (mm/dd/yyyy)  
*Last Name   Field of study
*First Name   Graduation Date
Middle Name Citizenship
Degree(if applicable) *Email  
*Reason for Departure




 
Address1
Address 2
City
Province/State
Country
Postal Code
Date of Departure (mm/dd/yyyy).
(If you are leaving for home country or for other reasons.)
Name of School Transferring to.
(If you are transferring to another university.)
Other Reason
(In case if you are departing for other reason.)