F1 Transfer-In Form
To be completed by the STUDENT
Last Name
First Name
Student ID# at the Current/Previous U.S. School
CBC ID# (if known)
First Academic Term at CBC
Home Phone# Cell Phone#
1. Do you plan to travel outside the U.S. before beginning your program at CBC?
q Yes q No
If Yes, please give departure and return dates: ____________________________________________________________________________
2. “I authorize my current/previous school to provide CBC with the information regarding my immigration status.
____________________________________________________________________________________ ____________________
Signature Date
at the current/previous school
Educational Level Sought Last Date of Authorized Attendance/Practical Training
Authorized Reduced Course Load (list all periods and reasons)
Authorized Curricular and/or Optional Practical Training (list all periods)
SEVIS Transfer Release Date
1. Based on the records of this office, it appears that the above named student:
q is
eligible for SEVIS school transfer pursuant to 8 CFR § 214.2.(f)(8).
q is not
2. Remarks
DSO’s Name Title
Signature Date
Email Phone
School Name and Address
Please mail or fax completed form to:
Columbia Basin College
International Student Program
2600 N. 20th Ave., MS-H4
Pasco, WA 99301
Phone: 509.547.0511 Fax: 509.544.2023
Email: internationalstu@columbiabasin.edu
Web: columbiabasin.edu/internationalstudents
Columbia Basin College complies with the spirit and letter of state and federal laws, regulations and executive orders pertaining to civil rights, Title IX, equal opportunity and afrmative action. CBC does not discriminate on the ba-
sis of race, color, creed, religion, national or ethnic origin, parental status or families with children, marital status, sex (gender), sexual orientation, gender identity or expression, age, genetic information, honorably discharged veteran or military sta-
tus, or the presence of any sensory, mental, or physical disability, or the use of a trained dog guide or service animal (allowed by law) by a person with a disability, or any other prohibited basis in its educational programs or employment. Ques-
tions or complaints may be referred to the Vice President for Human Resources & Legal Affairs and CBC’s Title IX/EEO Coordinator at (509) 542-5548. Individuals with disabilities are encouraged to participate in all college sponsored events and
programs. If you have a disability, and require an accommodation, please contact the CBC Resource Center at (509) 542-4412 or the Washington Relay Service at 711 or 1-800-833-6384. This notice is available in alternative media by request.