Predeparture Form for Non-Graduating Students

In order for this office to issue appropriate travel papers and keep accurate records, all international students must complete the section(s) which apply to them and return it to the Office for International Students and Scholars no later than Friday, May 10, 2013.  Please read carefully and complete as much as possible. You need only to complete the section, which applies to you.

If you are leaving the U.S. this summer please have your I-20 signed by Dean Tamzarian (Wright Hall 124) or Ashavan Doyon (Clark Hall 303). 

Name  
Class  

CHECK APPROPRIATE STATUS: 

. . . . . . . . . . . . . . . . . . . . . .

A: IF YOU ARE LEAVING THE U.S. ANYTIME DURING THIS SUMMER AND RETURNING TO SMITH IN THE FALL. Please have your I-20 signed by Dean Tamzarian.

What are your summer plans?

Summer Address

Country
Phone
Cell Phone

. . . . . . . . . . . . . . . . . . . . . .

B: IF YOU ARE STAYING IN THE U.S. THIS SUMMER AND RETURNING TO SMITH IN THE FALL:

1. Do you have a summer job on Smith campus?   
Yes    No 
Where? 
Phone: 

2. Do you have a summer job/internship off campus?
Yes    No 
Name of Company and Location 
Phone: 
Did you apply for Pre-graduation OPT?   
Yes    No 
Will you be doing any of the following internships this year?   
Praxis    Coulter 

3. Are you planning on studying abroad in the fall?   
Yes    No 

4. Do you plan to transfer to another school?  
Yes    No 

5. Will you be leaving the U.S. and not returning to Smith in the Fall?   Yes    No 
Please provide a permanent address abroad where we can reach you

Country

Permanent NON-SMITH email