FIU - ELI - F1 Student Exit Form

Please complete this form if you are an F1 (international student)
and this is your last term at FIU-ELI at this time.

Last Name (Primary Family Name)
Second Last Name (If Applicable)
First Name
Middle Name
E-Mail
Mobile Telephone (Ex.: 305-321-4567)

If this number is outside the U.S., please include the Country and City Code.
Date of Birth Date of Birth / MM / DD YYYY
Current Term
Are you an F1 international student?

Are you an F1 international student? Yes
At this time, is this your last term at FIU-ELI?

At this time, is this your last term at FIU-ELI? Yes
Do you understand that by submitting this form, the end date of your I-20 will be shortened to the end of the current term and you will have 60 days to transfer to another SEVIS approved school or leave the U.S?

Do you understand that by submitting this form, the end date of your I-20 will be shortened to the end of the current term and you will have 60 days to transfer to another SEVIS approved school or leave the U.S? Yes
SEVIS ID (I-20 Number):

The number is located in the upper left hand corner of your I-20 and starts with N00...
Comments:
Draw your signature into the box below.

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Full Name
Date Date / MM / DD YYYY