CIE - International Student Departure Survey

1. Student Information

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1. Name: (Required.)

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2. SEVIS Number (top right hand corner of I-20/DS-2019)

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3. Future Contact Information: (Required.)

Address: *

Address 2:

City/Town: *

State:

ZIP/Postal Code: *

Country: *

Email Address: *

Phone Number: *

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4. Gender: (Required.)

Male

Female

Other

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5. What is your academic standing? (Required.)

Exchange student

Freshman

Sophomore

Junior

Senior

Other

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6. What is your home institution (if applicable)?

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7. What is your citizenship? (Required.)

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8. What is your visa status? (Required.)

F-1

J-1

F-1 on OPT

Other

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* 1. Name: (Required.)

Question Title

* 2. SEVIS Number (top right hand corner of I-20/DS-2019)

Question Title

* 3. Future Contact Information: (Required.)

Question Title

* 4. Gender: (Required.)

Question Title

* 5. What is your academic standing? (Required.)

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* 6. What is your home institution (if applicable)?

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* 7. What is your citizenship? (Required.)

Question Title

* 8. What is your visa status? (Required.)

1. Name: (Required.)

2. SEVIS Number (top right hand corner of I-20/DS-2019)

3. Future Contact Information: (Required.)

4. Gender: (Required.)

5. What is your academic standing? (Required.)

6. What is your home institution (if applicable)?

7. What is your citizenship? (Required.)

8. What is your visa status? (Required.)