UC Davis Services for International Students and Scholars

F-1/J-1 Student Departure from the U.S.

I certify that I am departing the U.S. and have no intention to return to UC Davis or another U.S. school in the next 5 months.*
I understand my departure date will be entered in the SEVIS System, and I will not be eligible to re-enter the U.S. on my current SEVIS I-20/DS-2019.
It is my responsibility to notify SISS of any changes to my immigration status.
Note: If you are transferring to another school in the U.S., go to Transferring from UC Davis to another U.S. Institution.

This form means that you are leaving the U.S. and NOT returning in the next 5 months.

Student Information Last (Family) Name First (Given) Name UC Davis Student ID Email Address SEVIS ID Number¹ Are a gradutate student? Yes, I am a graduate student.
No, I am an undergraduate. Date of Departure

¹ SEVIS ID Number can be found at the top right corner of the I-20/DS-2019 form.

Reason for Departure

Choose a reason for departure. You must read the instructions that appear and answer any additional questions.

Completion of academic program or Optional Practical Training (F-1) / Academic Training (J-1)

F-1 students must depart the U.S. within 60 days from program completion or the end of the OPT period. Students on OPT do not have a grace period after reaching 90 days of unemployment during the initial 12 months of OPT or 120 days during the 29 months of OPT (including the 17-month OPT extension).
J-1 students must depart the U.S. within 30 days from program completion or expiration of the Academic Training.
What is the date of completion or end of your OPT/AT? (mm/dd/yyyy):

Early completion of Optional Practical Training (F-1) / Academic Training (J-1)

F-1 students must depart the U.S. within the remainder of their unemployment days (90 days maximum for post-completion OPT and 120 days maximum for OPT extension applicants). Example: Number of days remaining = 90 days - number of days unemployed
F-1 students must depart the U.S. within 15 days from the last day of employment.
J-1 students must depart the U.S. within 30 days from the last day of employment.
When is your last day of employment? (mm/dd/yyyy):

Early withdrawal from UC Davis

F-1 students must depart the U.S. within 15 days of last class attended.
What is the date of your last class attended? (mm/dd/yyyy)

*If you plan to return to UC Davis after a 5-month absence, contact your SISS International Student Advisor at http://siss.ucdavis.edu/contact.cfm