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ON TODAY S DATE MM/DD/YYYY : LAST NAME as it appears in passport : FIRST NAME as it appears in passport : SEVIS ID#: N STUDENT ID NUMBER: VISA STATUS: F-1 J-1 F-1/J-1 UNDERGRADUATE STUDENTS PLEASE INDICATE THE REASON YOU WILL LEAVE UCI BELOW: I have completed my degree program/non-degree program and will not apply for OPT/Academic Training. i I have completed my OPT and will be leaving the U.S . ii I am withdrawing from UCI. iii I will be attending another U.S..
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