Exit Form for F-1/J-1 Visa Holders
This form is to be used by F-1/J-1 visa holders who are permanently leaving SIUE.

Last/Family Name *
Your answer
First/Given Name *
Your answer
SIUE Email Address *
Your answer
SIUE I.D. (800#) *
Your answer
Current U.S Address (Street, City, State & Zip) *
Your answer
Current U.S Phone Number *
Your answer
Permanent non-SIUE Email *
Your answer
Major Area of Study/Research *
Your answer
Program Completion Date *
MM
/
DD
/
YYYY
Immigration Status (F or J Visa) *
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