F-1 Transfer-In Form
2 01905-043
PART I: To be completed by the transferring student (print or type)
Name_____________________________________________________________________________________________________________
Surname Given Name
Date of Birth __________________________________ Country of Citizenship ________________________________________________
MM/DD/YYYY
Are your F2 dependents in the U.S. now? Yes No
Email ____________________________________________________________________ Pho ne _____________________________________
Term yo u intend to tr ansfe r to Nor th ern Essex Communit y Coll ege ___________________________________________________________
Student’s Signature __________________________________________________________________________________________________
Part II: To be completed by International Student Advisor (PDSO or DSO)
Please complete and return to NECC with copies of the student’s Form I-20.
What is the student’s current visa status? _____________________________________ SEVIS ID # _________________________ ______
Name of your institution ____________________________________________________________________________________________
Student was last pursuing a full course of study during which term? (check one): Fall Spring Summer
Previous program of study/major ___________________________________________________________________________________
Has this student been authorized for Curricular and/or Optional Practical Training? Yes No
If yes, what are the dates and type of practical training? _______________________________________________________________
_____________________________________________________________________________________________________________________
To the best of your knowledge, is the student noted above in status according to DHS regulations for a transfer?
Yes No If no, please provide an explanation ____________________________________________________________________
Are there any dependents in the student’s SEVIS record? Yes No If yes, how many? __________________________
Dates of attendance at your institution: From ______________ to _________________
SEVIS Transfer release date __________________ Northern Essex Community College Code is: BOS214F0641000
Please note that releasing the student’s record in SEVIS indicates that the student is eligible to transfer from your school to another
SEVIS school in the U.S.
Th i s fo r m was c ompl e ted b y ____________________________________________________ Titl e __________________________________________
Email ____________________________________________________________________Pho ne _____________________________________
Signature _____________________________________________________________________ Date __________________________________________
Please return this form to:
International Student Oce | 100 Elliott Street | Haverhill, MA 01830 | Phone: 978-556-3726
Fax: 978-738-7450 | Email: international@necc.mass.edu
INSTRUCTIONS: Please complete Part I and then submit it to your international student advisor
at the school you currently attend or most recently attended to complete Part II.
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