PCC ID#:______________________ SEVIS ID#: N00___________________________
Major: First Semester at PCC
: _________________ I-20 Expira on Date: _______________________
mm/dd/yyyy
___________________________
I-20 Extension Recommendation Form
Student to complete:
Student Name: ___________________________________ _______________________________________________ ___________
Family Name First Name MI
Date of Birth: __________________
Phone#: _______________________
Email address: ____________________@go.pasadena.edu
mm/dd/yyyy
______________________________ ___
Eligibility Criteria for an I-20 Extension:
Student must be making normal academic progress towards comp on of academic program, and must have
academic requirements remaining.
By law [8 CFR 214.2(f)(7)(iii)], delays caused by academic prob on is NOT an acceptable reason for an I-20
extension.
Academic Conselor to complete:
Reason for delay:
Change of major
Courses not offered in appropriate semesters
Extensive prerequisite courses
In
al placement into low ESL level
Documented medical reasons (student will need to show documenta
on to ISC)
Other (please explain):
As the academic counselor, please verify whether or not the following statements are true:
Student is in good academic standing and is mee ng college expecta ons in academic progress and performance.
nue studying at Pasadena City College.
I support the student’s request for an extension on his or her I-20 to con
I have provided the student with a new education plan
Expected date of comple
on:
semester, year
Major:
____________________________________
Academic Counselor Signature
_____________________________
Printed Name/Ext.
_____ ____________
mm/dd/yyyy
ISC staff to complete:
Unit # _____ SEVIS SARS Request log
Ema
il A&R Email student
Initial: ______ Date: _______
Important Note: All paperwork requests require 10 business days to process. revised 4/25/2018
