J-1 Exchange Visitor Exit Interview

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First Name

Last Name

Banner ID

ACU Email

Phone

Please provide your exact departure date from the US:

If you could, please tell us why you are leaving ACU:

Completion Date

NOTE: If you are changing programs at ACU or starting a new program elsewhere, please meet with the A/RO in the CIE to discuss your plans.

What date did you complete your program?

If other, when is your completion date?

Please select that which applies:

Do you acknowledge that your record has been terminated and you must leave the US within 15 days from the termination date in SEVIS?

Yes, I do

Do you acknowledge that your record has been terminated and you must leave the US or file for a reinstatement immediately? There is no grace period.

Yes, I do

What will you do next? (Select all that apply)

I will notify the Depot and settle my accounts before leaving.I will leave the US within 30 days of the end of my enrollment at ACU.I will meet with a Responsible Officer and transfer out for the next available semester.Other

Please explain your future plans:

Do you certify that everything marked on this form is true and correct, and also acknowledge that you must terminate any on-campus employment by end of your enrollment or DS2019 at ACU, whichever is earlier.

Yes, I do

Exit Questions

Did you attend the ACU international student orientation when you first arrived at ACU?

Do you consistently read your ACU International Office email?

Please rate our office services on how valuable they have been for understanding compliance with government regulations:

Orientation

ACU CIE Email

CIE Website

CIE "Maintaining F-1 Status"

CIE walk-in hours

CIE appointments with advisors

The Department of State is interested in each Exchange Visitor's cross-cultural experience. Please answer the following questions, rating each between 1 (low, or do not agree) to 5 (high, or strongly agree):

I have learned and experienced US culture at ACU.

I am satisfied with the amount of cultural exchange I experience.

I would like to share this experience with colleagues back home.

I was given enough opportunities to experience US culture during the time I had.

What aspects of US culture have made the deepest impression on you the most during your time here? What caused you to experience this?

What was one of the most influential cross-cultural experiences you had while you were at ACU?

If you are interested in getting involved with an ACU international alumni network back in your home country, please provide your complete home contact information:

Address

Phone

Other (Facebook, LinkedIn, QQ, etc.)

Would you be willing to share this with the Department of State in support of the Exchange Visitor Program?

Please share any suggestions on how our office can improve services to you and to future students:

Additional Comments / Concerns

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