Cleveland State University

Center for International Services and Programs

Departure Form for International Students and Scholars at CSU

We are asking all students and scholars to complete this form before they leave the United States or CSU permanently so that we are able to keep accurate SEVIS/school records and provide appropriate services to you.

Personal Information
Last/Family Name
First Name
Middle Name
CSU ID #
Visa Status
Academic Status
Degree Received
Bachelor's
Department
Master's
Department
Ph. D.
Department
Country of Birth
Country of Citizenship
New (Forwarding) Address
Forwarding Phone
Forwarding Email
Home Country Address
Home Country Phone
Home Country Email
Dates of Departure (MM/DD/YY):
from Cleveland
from United States
What are your immediate future plans?
I will stay in the US
  Pursuing further studies at     
  Beginning employment at     
  Beginning Optional Practical Training
  Other 
Would you like to be included in an alumni electronic distribution list and receive CSU emails?
Please give an email address you would like us to use.
Would you like to assist CSU in your home country with the recruitment of future CSU students or be contacted by CSU students/faculty studying in your home country?
If yes, we will send you more information about these programs.
May we share your contact information with other CSU alumni/students?

    

Departure Reminders
1. Close out leases, utilities, and request return of deposits
2. Leave your forwarding address at CISP
3. Ship books and personal belongings home
4. Make sure to pay all your outstanding bills
5. File your income tax form after you return.

Contact US Embassy or http://www.irs.gov for more information
In addition we ask that you complete a survey of our services which can be sent anonymously. CLICK HERE

engaged learning
Mailing address
Cleveland State University
Center for International
Services and Programs
2121 Euclid avenue
Cleveland, OH 44115-2214
Campus Location
Main Classroom, Room MC106
1899 East 22nd Street
Phone: 216.687.3910
study@csuohio.edu


This site contains files that require the free Adobe Reader to view.


© 2012 Cleveland State University | 2121 Euclid Avenue, Cleveland, OH 44115-2214 | 216.687.2000

Affirmative Action | Diversity | Employment