3200 Main Street, Houston, TX 77002 T 713.718.8521 F 713.718.2112 W hccs.edu Rev. 8/2015
Dear Prospective Student,
To complete your transfer application to Houston Community College and issue you the SEVIS I-20 form, we
must have an F-1 International Student Transfer-In form completed by your Designated School Official (DSO)
at your current institution. Your signature authorizes the following information to be released to HCC.
________________________________ ________________________________ ____________________________
Student’s Last Name First Name Middle Name
________________________________ ________________________________ ____________________________
Date of Birth (mm/dd/yyyy) Country of Citizenship Transfer Semester
____
___________________________
Student’s Signature
____
________________________
Date
Designated School Official (DSO): Please answer the following questions about the student named above.
Retu
rn form to:
Houston Community College
3100 Main Street MC 1138 Phone: 713-718-8521
Houston, TX 77002 Fax: 713-718-2112
1. Ty
pe of visa________ 2. Dates of enrollment: from_______________________ to __________________________
3. Program of study______________________ 4. Estimated date of completion _______________________________
5. Is the student currently in legal status with immigration? Yes____ No____
6. Can the student return to your institution? Yes____ No____
If no, please explain. _____________________________________________________________________________
7. Off-campus employment authorization? Yes____ No____
If yes, what kind and dates?_______________________________________________________________________
8. Previous authorization for reduced course load? Yes____ No____
If yes, what kind and dates?_______________________________________________________________________
9. Other comments ________________________________________________________________________________
A letter of acceptance will be submitted by an HCC DSO AFTER this form is received and approved.
_______
____________________________________________ ____________________________________________
Name of Institution Date
_______
____________________________________________ ____________________________________________
Name of School Official
(Please Print) Signature
______________
___________________ __________________________________ _______________________________________________________________
Telephone Fax: Email:
F-1 International Student Transfer In Form
Houston Community College School code:
HOU214F00354000
HCC ID: ________________________
SEVIS ID: N_____________________
____
___________________________
Student’s EMAIL (important: please provide
provide an email address where the OISS will contact
you regularly regarding your transfer)
