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:

• By signing this form, I confirm my plans to leave the U.S. within 60 days (for F-1) of the completion of my academic program.
• I understand that my SEVIS record shall be “completed” or “inactivated”. Once “completed/inactivated”, my SEVIS record cannot be reactivated. In order to return to the U.S. and study, I will need to apply for admission and obtain a new SEVIS I-20/DS-2019.

Signature: Date:

ISS OFFICE USE ONLY

Action Taken (Shorten or Complete)

DSO Date