F-1 Exit Form

All F-1students who are exiting Mt. SAC are required to complete this “exit form.” The information contained in this form will be used by the Admissions Office.

Section A

*Student A Number

*First Name

Middle Name

*Last Name

Nickname

*Personal Email Address

*Academic Major

*Program End Date (As listed on your I-20)

Do you wish to share your mailing information with Mt. SAC Alumni Services

Yes

Section B

U.S. Mailing Address: (No work or P.O. Box addresses please)

Street Name and Number

City

State

Zip Code

Primary Phone Number

Home Country Mailing Address: (No work or P.O. Box addresses please)

Street Name and Number

Country

City

State

Postal Code

Section C

Ae you leaving Mt. SAC prior to completing your academic program?

Yes

If you answered "No" above, please go to Section D of this form.

If you answered "Yes" above, what is your reason for leaving prior to your program completion?

Financial Reasons

Transferring to another institution

Change of Status

Lack of Available Courses

Academic Reasons

Decline to State

Other

If you answered "other" above, please expand on this answer

Section D

Type of Degree

Associate

Certificate

At the conclusion of an academic program, F-1s have 60 days to leave the US, start another academic program or begin Optional Practical Training. Please state your future plans below.

Future Plans

Returning to home country

Returning to another country

Remaining in the U.S. - Transferring schools

Remaining in the U.S. - Optional Practical Training (OPT)

Remaining in the U.S. - Applying for a new Degree Program at Mt. SAC

Applying for permanent residence

Applying for change of status

If you answered "Returning to home/another country" above, please state your departure date

Signature of Approval

By clicking this button, I am providing my signature to this document

*Date of Signature

Additional Comments

Student Comment Section: We would like to hear any comments about your college experience that might help us improve our services to International Students. Please let us know. Thank you

Your Comments