Scholar Departure Form

This form lets ISO know that that you’re:

Leaving the US and won’t have J-1, H-1B, O-1, or TN status with the University of Rochester, either because of normal program completion or early termination/withdrawal
Leaving the University of Rochester but staying in the US in a valid status like a change of status to another immigration category, J-1 transfer, or H-1B portability to another employer/institution
Taking a temporary leave of absence: If you’re going on an extended absence from the US, use this form to let ISO know in accordance with J-1 status reporting requirements

This form will only notify the ISO. You might also need to contact other University offices like Human Resources (HRMS) or Payroll. Please let us know your last day of work and your departure date.

Scholar Departure Form

Full Name(Required)

(As it appears in your passport)

Date of Birth(Required)

Email(Required)

Scholar Category(Required)

Departure Information

Last day of work at UR

Departure Date from U.S., if applicable

Reason for Departure(Required)

Forwarding Address (if known/applicable)

Additional Information

If taking a leave of absence/extended absence from U.S., how long will you be away? What is your anticipated return date?