Student Departure Form

Please use the Student Departure Form on this page to notify the ISO that you won’t be continuing your F-1 or J-1 program through the University of Rochester, and/or if you’ll be departing the United States. Reasons for departure may include:

Finishing your studies
Transfer/transferring to another school
Taking a leave of absence or early withdrawal
End of post-completion employment
Approval for Change of Status to another immigration category

Don’t use the Student Departure Form to report a short trip home or vacation.

Some of the departure situations might require additional documentation and forms before ISO can help. Please review the following forms and information, as needed:

This form below will only notify the ISO. You might also need to contact any other University offices like University Health Service or Residential Life.

Student Departure Form

Full Name(Required)

(Please list your name exactly as it appears on the I-20/DS-2019)

Date of Birth(Required)

University ID#(Required)

Email Address(Required)

Student Visa Category

Departure Information

Planned Departure from the United States(Required)

Scheduled

Unknown

Not Applicable

Departure Date

(If “Scheduled”)

Reason for Notification(Required)

Forwarding Address (if known)

Additional Info / Comments