ࡱ> dfca 2bjbj .BxEbxEb .....BBBBB$tyTT!$$$$$$$$5&(T*$Q.yy*$..{$a a a ..$a $a a H##{1c.`##$0$h#,?)P?)#?).#\a *$*$a $?)B :  International Student Services SEPARATION FORM Rev. 05/19 Students who fall into one or more of the categories below should complete this form. (Please check all that apply):  FORMCHECKBOX  I am completing my academic program at ɫֱ this semester  FORMCHECKBOX  I am finishing my OPT this semester  FORMCHECKBOX  I am transferring to another U.S. institution  FORMCHECKBOX  I am withdrawing permanently from NSU  FORMCHECKBOX  I am changing (or have changed) my visa status to another category or have obtained permanent residency Name:  FORMTEXT        FORMTEXT       (Last/Family Name) (First/Given Name) Student (NSU) ID Number:  FORMTEXT       Local Phone Number:  FORMTEXT       Expected Graduation Date:  FORMTEXT       Major:  FORMTEXT       NSU Email Address:  FORMTEXT       Forwarding Mail Address: Start date:  FORMTEXT      /  FORMTEXT      /  FORMTEXT       until  FORMTEXT      /  FORMTEXT      /  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       Immigration Status:  FORMCHECKBOX  F-1  FORMCHECKBOX  J-1  FORMCHECKBOX  Other Current Academic Status:  FORMCHECKBOX  Associate s  FORMCHECKBOX  Bachelor s  FORMCHECKBOX  Master s  FORMCHECKBOX  Doctorate  FORMCHECKBOX  Other (please specify) NOTE: At the conclusion of an academic program, F-1 visa holders have 60 days and J-1s have 30 days in which to (i) prepare for departure from the U.S. (ii) change immigration status (iii) move on to another program level at the same school (iv) transfer SEVIS record to another U.S. university, or (v) begin practical/ academic training (request must have been submitted prior to program end date.) 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NOTE: If this option is selected, please complete the  Form for Transfer of SEVIS Record to have your SEVIS record transferred to the new school.  FORMCHECKBOX  Apply for a change of status to  FORMTEXT       status. If you have a notice from the USCIS, please attach a copy.  FORMCHECKBOX  Continue to study at Norfolk State University. 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