P e r a l t a C o m m u n i t y C o l l e g e D i s t r i c t
Berkeley City College | College of Alameda | Laney College | Merritt College
Office of International Education • 333 East 8
th
Street, Oakland, CA 94606
Tel. (510) 466-7380 • Fax (510) 465-3257 • Email international@peralta.edu
www.peralta.edu • https://web.peralta.edu/international
Certification of F-1 Student Status
Transfer-In Form
Dear international student, please complete the section A and submit the form to your current Designated School Official
(DSO). The DSO must complete section B. The form may be returned by email, fax or in person in order to be processed.
A. TO BE COMPLETED BY THE STUDENT:
Name (Last, First): Peralta Student ID:
SEVIS ID: Phone: Email:
Address: City, State, Zip:
It is my intention to attend the (select one) Spring
Berkeley City College College of Alameda
Summer
Laney College
Fall
term at:
Merritt College
SFR214F00296004 SFR214F00296002 SFR214F00296000 SFR214F00296003
DSO: Please search for “Peralta Community College District”
I request that you provide the Peralta Community College District with the information listed below:
Student Signature: Today’s Date:
B. TO BE COMPLETED BY DESIGNATED SCHOOL OFFICIAL (DSO):
Name of Institution:
Address: City, State, Zip:
DSO Name: Phone: Email:
Language Schools only: What is the student’s current English level at your institution?
What dates did the student attend?
Please select if:
The student is in status and is eligible to transfer
The student is not in status and their I-20 (SEVIS record) has been Terminated/Completed on this date
The Peralta Colleges may rescind acceptance of students out of status. If the student is not in status, please do not release the I-20 unless a DSO
from PCCD verifies that we will pursue Reinstatement with the student.
Comments/Other:
Last Date Attended:
SEVIS Transfer Release Date:
DSO Signature: Today’s Date:
Please do not release I-20 without receiving an acceptance letter from the Office of International Education
