Status Change Confirmation Form

This form is to report your status change. ISS will take an action on your SEVIS record or contact you after reviewing. Please contact iss@okstate.edu if you have any questions.

Last name:
First name:
CWID / Banner ID:
SEVIS ID:
Current Address: Current Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email address:
Phone Number Phone Number - ### - ### ####
Status change reason
Departure date Departure date / MM / DD YYYY
I confirm that I do not intend to return to the United States with same SEVIS ID

I confirm that I do not intend to return to the United States with same SEVIS ID
I request my SEVIS record manual completion after the departure and understand there is no grace period.

I request my SEVIS record manual completion after the departure and understand there is no grace period.
New status type:
Change of status application approval date: Change of status application approval date: / MM / DD YYYY
Upload evidence (I-797A, Green Card, EAD, etc):

Attach Files
I request that my SEVIS record be terminated while my change of status application is pending. I understand that a pending Green Card application does not constitute an immigration status, and therefore, if my change of status application is ultimately denied, I may be out of status.

I request that my SEVIS record be terminated while my change of status application is pending. I understand that a pending Green Card application does not constitute an immigration status, and therefore, if my change of status application is ultimately denied, I may be out of status.
I request my SEVIS record be terminated for reason of change of status approval.

I request my SEVIS record be terminated for reason of change of status approval.
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.