Fillable NOTICE OF DEPARTURE FORM (University of Akron)

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NOTICE OF DEPARTURE FORM (University of Akron)

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The NOTICE OF DEPARTURE FORM (University of Akron) form is 1 page long and contains:

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  • 6 check-boxes
  • 25 other fields

Country of origin: US
File type: PDF

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Office of Student and Scholar Immigration Services, Polsky 467, The University of Akron, Akron, OH 44325-2101
Email: immigration@uakron.edu Phone: 330-972-6349 FAX: 330-972-6475
NOTICE OF DEPARTURE FORM
Please do not use this form if you are leaving for a school break or transferring to another school.
Name: Last (Family) First (Given) Middle UA ID#
Date of birth (mm/dd/yyyy) Visa status Email address
You are leaving the USA for the following reason (please check the appropriate box):
Reason for Leaving the
USA
Date of
Program
Completion/
Termination
Date of
Departure
Date of
Re-entry
Comments
I withdraw from my
program during the
semester because I need
to leave the USA; I am
planning to come back
next semester (within 5
months)
• You may stay in the USA for 15 calendar days upon
submission of this form to the OIS.
• Your SEVIS record will be terminated.
• Contact us within 60 days before
the next semester starts
to request re-activation of your SEVIS record.
• You may re-enter within 30 days of the semester
start date.
Your SEVIS record must be active at
the time of re-entry.
I withdraw from my
program and leave the
USA. I am not sure
whether I will come
back
• You may stay in the USA for 15 calendar days upon
submission of this form to the OIS.
• Your SEVIS record will be terminated.
• If you decide to come back after the break of more
than 5
months, you will need to request a new I- 20/DS-2019; you
will need to submit a letter from
the academic department
about eligibility to resume your program.
• If absent for more than one year, contact Admissions for the
readmission process.
• Contact OIS for information on re-entry.
I am on OPT or STEM
OPT and will be leaving
the U.S. before the end
date of my OPT
• I am aware I am forfeiting any remaining time on OPT.
I am leaving the USA to
do research abroad that
is needed for my
program at UA (Ph.D.
Student)
• Please submit proof of registration for the
research and a
letter from your academic advisor
describing the necessity of
your research abroad.
• Have your I-20/DS-2019 signed for re-entry.
• Your SEVIS record will remain active.
I am leaving the USA for
study abroad
• Please submit a letter from the study abroad coordinator;
upon completion of the study abroad,
submit your transcript.
Other
Upon reentry to the U.S., please submit your immigration documents (passport and visa) to the OIS.
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NOTICE OF DEPARTURE FORM (University of Akron)

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Completed 28 August 2020

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