Return completed form to:
International Student Services
Seward County Community College
F-1 and Students Graduating or Leaving SCCC and Leaving the U.S.
Family/Surname(s) Given Name(s)
SCCCID: SEVIS ID:
My departure date is__________________________(exact or approximate).
Non-SCCC Email address:
ISS OFFICE USE ONLY
Action Taken (Shorten or Complete)