Going Home Notice
July 2012
Student Information
Name: Date of Birth:
Last First
Phone: Cascadia Student ID #:
Email:
Local Mailing address:
Signature: Date:
Study Program: ____________________________________________________________________________
Did you complete your degree/program? (circle one) YES / NO
If No, explain: ______________________________________________________________________________
(e.g. withdrawal, family emergency, medical condition, etc.)
SEVIS ID: N____________________________
I am returning home to my country, AND… (choose only one):
I have no plans to return to the U.S. in the future.
It is possible that I will return to the U.S. but not to Cascadia. If you will transfer to another
college/university soon, remember to complete International Programs’ transfer out request form.
It is possible that I will return to Cascadia for _________ (quarter) ______ (year)
My last quarter of study at Cascadia will be: Fall / Winter/Spring/Summer Year: ________
Estimated Date of Departure from U.S.: _____ / _____ / _____ (month/day/year)
Student’s Signature Date
NOTE: If you are returning home, your I-20 from Cascadia becomes invalid as of the last day of your attendance. You
will not be able to use it to re-enter the U.S. (this includes trips to Canada).
To be completed by the International Programs Office
Advisor’s Initials Advisors Printed Name Date
□ Scan and E-file □ Email the student □ Update Database □ Update SEVIS
Cascadia College is an equal opportunity institution and does not discriminate on the basis of race, color, religion, gender and/or sex, disability, national origin,
citizenship status, age, sexual orientation, veteran’s status, or genetic information. All Cascadia materials are available in alternative formats and can be requested by
contacting the Human Resources office.
FILL