International Student and Exchange Visitor Departure Notice

Current International Student and Scholar Departure Notice
Complete

Occasionally, and for a variety of reasons, students and scholars leave the University early or unexpectedly. Some of these reasons include early graduation, leave of absence, suspension, expulsion, or family emergencies. You are required to inform the Office of International Affairs if you plan to leave the University before the date on your immigration document (I-20 or DS-2019) and provide the reason for doing so. You can do this by completing this form and returning it to our office prior to your departure. This form should not be used for summer vacations or school breaks.

First

Middle

Family/Last

Academic Status

Student

Research scholar or professor (non-student)

Immigration Status

F-1

J-1

H-1B

Other (please specify)

Forwarding Address

New Email Address (list email other than NCCU address)

May we give your forwarding address to others who inquire?

Yes

Dates of Expected Departure

From Durham:

From the U.S.

What are your future plans?

Returning to home country permanently. I do not plan to be at NCCU.

Returning to another country. I do not plan to be at NCCU next semester.

Taking a leave of absence with the intention of returning to NCCU at a later date.

Remaining in the United States for optional practical training or academic training.

Remaining in the United States.

Remaining in the United States at another employer or institution.

Date Leaving U.S.:

Will you change your visa status?

Yes

If you will change your visa status, what will be your new visa status?

Will you transfer your current visa status to the new institution?

Yes

Signature

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Signature Date

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