EXIT QUESTIONNAIRE FOR UTMB INTERNATIONAL STUDENTS AND SCHOLARS

Please complete this form if you are leaving UTMB to return to your country of residence, or have applied for a change of visa status or transfer to another school.  Your feedback about your experiences at UTMB and in the United States, will help us to serve other international visitors and is appreciated.

Note: If you would prefer to print this form and deliver it by hand, please click here.

NAME:  

EMPLOYEE I.D. Number:    

NAME OF EMPLOYING OR SPONSORING UTMB DEPARTMENT:

 VISA TYPE:  

B-1   B-2    F-1   J-1   H-1B    O-1   TN   WT   WB  H-4   

J-2 (dependent of student)  J-2 (dependent of other J-1)  Adjustment Applicant  

Legal Permanent Resident   Other   

IF J-1 VISA, MARK EXCHANGE VISITOR CATEGORY LISTED IN SECTION [ 4 ] OF FORM DS-2019:    

  Student     Professor       Alien Physician       Research Scholar      Short-Term Scholar

IF J-1 VISA ‘RESEARCH SCHOLAR’ PLEASE READ AND SIGN STATEMENT BELOW:

I am aware that I may extend my J-1 ‘Research Scholar’ status for up to five years from my initial date of arrival in the United States in that status.  I am also aware that if I leave the United States in under five years from my initial date of arrival I will not be able to return to this country as a J-1 ‘Research Scholar’ for two years from the date on which my SEVIS record becomes “inactive.”

 FUTURE PLANS:

Please check appropriate item(s):                  

Leaving  the US; Date of expected departure from US: 1 2 3 4 5 6 7 8 9 10 11 12   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   2007 2008 2009 2010 2011   (MM/DD/YYYY)

F-1 Practical Training or J-1 Academic Training beginning 0 1 2 3 4 5 6 7 8 9 10 11 12   0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   0 2007 2008 2009 2010 2011   (MM/DD/YYYY)

Transferring to another school in the US beginning 0 1 2 3 4 5 6 7 8 9 10 11 12   0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   0 2007 2008 2009 2010 2011   (MM/DD/YYYY)

Applying for a change of visa status to Not Applicable B-1/B-2 F-1 J-1 Research Scholar J-1 Short Term Scholar J-1 Student H-1B TN O-1 Permanent Resident status           

J visa holders only:                 

If transferring to another J-1 Exchange program:

Name of institution:    and program number:

  Please Note!

Legal Status:  At the conclusion of your academic program F-1s have 60 days and J-1s have 30 days, in which to: leave the US, change immigration status, move to another program level, obtain admission to another US university or begin Practical/Academic Training 

Taxes:  In January of each year UTMB sends a W-2 form to individuals who received UTMB taxable wages during the previous calendar year.  Depending on the type of income you earned and other variables, UTMB may also issue you a 1042-S form at that time.  Be sure to advise your UTMB employing department of the address to which these forms should be sent. Income tax return forms can be obtained overseas at the US Embassies or can be downloaded from the IRS website at http://www.irs.gov .

 Thank you for completing and returning this form.  Please comment on your UTMB experience on the back..  We hope the time you spent at UTMB and in the US was rewarding and positive.  (Please see next page)

 Departing International Staff Feedback About the UTMB / U.S. Experience

 Your additional comments and reflections about the time you spent at UTMB and in the US would be most appreciated. The purpose of this part of the form is to better understand the experiences you had so that we in turn can improve our services to better help our international community at UTMB. This is an optional form and can be submitted separately from the first page. 

 What did you find most challenging or different when you first came to UTMB?

In the months/years you have spent at UTMB and in the US, were there any experiences (both on campus and off campus) that made a positive impression or contribution to your experiences as an international?  Please describe briefly.

3.       If you had any negative experiences at UTMB or in the community please describe them briefly.

 What would have made your transition to life at UTMB and in the US easier and what would you have liked to know before you arrived at UTMB?

What programs and services would you like to see UTMB, including the Office of International Affairs, provide to international students and scholars?

Comments, questions and other reflections you would like to share (continue on back if necessary)