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 (Required)

Current F or J student
Former F or J Student
J Scholar Or Faculty

Last Name		Field of study
First Name		Graduation Date
Middle Name		Citizenship
Degree(if applicable)		Email
(Following Field is Required)

I plan to leave for my home country
I have applied for practical training
I am transferring to another university
I am entering military service
Other (leave of absence, illness, family emergency, withdrawal, etc)

Address1
Address 2
City
Province/State
Country
Postal Code
Date of Departure (mm/dd/yy)
(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)