Scholar Departure Form

Please use the form below to notify the ISO that you are :

Departing the U.S. and will no longer maintain J-1, H-1B, O-1, or TN status with the University of Rochester (due to normal program completion OR early termination/withdrawal)
Leaving the University of Rochester, but staying in the U.S. in a valid status (e.g. change of status to another immigration category, J-1 transfer or H-1B portability to another employer/institution)

You may also use this form to report that you are taking a temporary leave of absence or are reporting an extended absence from the U.S. in accordance with J-1 status reporting requirements.

The Scholar Departure Form below will notify only the ISO. Please make sure to contact any other University offices that may need to be aware of your departure, such as Human Resources (HRMS) or Payroll, GLACIER tax software, etc. Please be sure to indicate your last day of work and your departure date.

* Full Name:	(As it appears in your passport)
* Date of Birth:
* E-mail address:
* Scholar Category:

Departure Information

Last day of work at UR:
Departure Date from U.S., if applicable:
* Reason for Departure:
Forwarding Address (if known/applicable):
Additional Information:
If taking a leave of absence/extended absence from U.S., how long will you be away? What is your anticipated return date?:
* Electronic Signature:	By checking this box, you request that ISO take appropriate action(s) to your immigration record.

Scholar Departure Form

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