Please fill in a valid value for all required fields

Please ensure all values are in a proper format.

Are you sure you want to leave this form and resume later?

Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.

You must upload one of the following file types for the selected field:

There was an error displaying the form. Please copy and paste the embed code again.

There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue.

J-1 Scholar Departure Form

DEPARTURE REPORT FOR J-1 EXCHANGE VISITORS

For record-keeping and immigration reporting purposes, the International Student & Scholar Services unit needs to know when the visiting scholar leaves the University of Colorado Denver. Please complete this form within 2-3 weeks prior to the scholar's departure. This form should be completed by the Department Administrator/Contact for each department.

After completion of this form, another followup form will be sent to faculty advisors and J-1 scholar's on their experience during the J-1 program at the University of Colorado Denver | Anschutz Medical Campus.

This form does not need to be completed if the J-1 scholar is changing status to another VISA at the University of Colorado Denver | Anschutz Medical Campus.

University/Affiliate Requesting Organization*

Department Contact Information

Dept Contact Name*

First Name

Last Name

CU Denver | Anschutz School or College*

School, Department, or Unit*

Job Title*

Email*

Confirm Email *

Dept Speedtype for DS-2019 Shipment*

Speedtype will only be used in the instance that the J-1 scholar is finishing their program early, and ISSS is 'shortening' the end-date for the scholar's DS-2019. Due to our restriction from the Department of State we are unable to send electronic copies of DS-2019s as updated documents directly to the J-1 scholar. IF we are not shortening the end date, the speedtype will not be used to ship the document to the J-1 scholar. Contact isss@ucdenver.edu if you have any additional questions.

Faculty Sponsor Information

Faculty Name*

First Name

Last Name

CU Denver | Anschutz School or College*

School, Department, or Unit.*

Job Title*

Faculty's E-mail*

Confirm Faculty's E-mail *

J-1 Scholar Departure Form

Department Contact Information

Scholar Information

Faculty Sponsor Information