International Programs
96-045 Ala Ike
Pearl City, Hawaii
96782
Phone: (808) 455-0570
Fax: (808) 455-0568
www.lcc.hawaii.edu/ipo
F-1 Transfer Student Verification of Enrollment
THIS FORM IS REQUIRED IF YOU CURRENTLY ATTEND SCHOOL IN THE UNITED STATES AND WANT TO TRANSFER TO LEEWARD COMMUNITY COLLEGE.
SECTION A: TO BE COMPLETED BY TRANSFER STUDENT
Applicant’s Name
: __________________________________________ Date of Birth: _____________
Last First Middle Month/Day/Year
Select the following:
I will travel outside the United States prior to enrolling at Leeward Community College
I will not leave the United States prior to enrolling at Leeward Community College
Applicant’s Signature:
__________________________________________ Date: _____________
Your signature authorizes the release of the following information to Leeward Community College
SECTION B: TO BE COMPLETED BY ADVISOR/SCHOOL OFFICIAL AT STUDENT’S CURRENT SCHOOL
Student SEVIS ID: _____________________ Leeward Community College SEVIS Code: HHW214F00244000
Transfer Date: Please transfer student in SEVIS once you have been notified of student’s acceptance to LCC
Enrollment Dates: From _
____________________ To _____________________ (or current session end date)
Month/Day/Year Month/Day/Year
Please select one of the following:
The student is enrolled full-time and has been maintaining all regulations governing F-1 students
The student is out of status and will need to apply for reinstatement with USCIS if transferred in SEVIS.
The student is on Optional Practical Training with an end date of: ______________________________
Month/Day/Year
Additional Comments:
_______________________________________ _______________________________________
Name of School Official Completing Form Signature
_______________________________________ ______________________________________
Name of School Date
_______________________________________ ______________________________________
Address Telephone Number
_______________________________________ _______________________________________
City, State, Zip Code Fax Number
P
LEASE FAX TO LEEWARD COMMUNITY COLLEGE INTERNATIONAL PROGRAMS: (808) 455-0568
