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Exit Form

This form is to be used by F-1 or J-1 Visa holders who are permanently leaving SIUE.

Family (Last) name
Given (First) name
SIUE Email Address
Student ID#
Address (Street, City, State & Zip) 
Current U.S Phone Number
Permanent non-SIUE Email 
Major Area of Study
Program Completion Date

What type of visa are you holding?


Will you be staying in U.S after graduation ?


Have you applied for OPT ?


If you are continuing your education, please complete the following:

Name of University
Start Date
Degree Program

What date are you departing from U.S ?(mm/dd/yyyy)

*** Please email your travel itinerary to the International Programs Office at

*** Depart from U.S within 60 days of your graduation date.

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