Return completed form to:

International Student Services

Registrar’s Office

Seward County Community College

EXIT INFORMATION

F-1 and Students Graduating or Leaving SCCC and Leaving the U.S.

Name:

Family/Surname(s) Given Name(s)

SCCCID: SEVIS ID:

My departure date is__________________________(exact or approximate).

Forwarding Address:

Non-SCCC Email address:

Signature: Date:

ISS OFFICE USE ONLY

Action Taken (Shorten or Complete)

DSO Date