Family
First
Email:
Fall (August) Spring (January) Summer (May/June)
Student’s signature
Yes
No
Yes
No
Academic
Medical:
How many semesters:
Yes
No
Yes No
Name of DSO
Phone:
DSO Signature
INTERNATIONAL STUDENT TRANSFER RELEASE AND VERIFICATION
Instructions:
• Complete Section 1 of this form.
• Contact the designated school ofcial (DSO)/international student advisor at your current school and determine an appropriate
Student and Exchange Visitor Information System (SEVIS) release date for your transfer. The transfer release date must be:
o After you have completed all coursework and employment at your current school; and
o No later than 60 days after completion of studies or optional practical training (OPT) at your current school; and
o Prior to your orientation and/or course registration date at Elgin Community College.
o Note: you must begin your program at ECC within 5 months of completing your program at your current school.
• Have a DSO at your current school complete Section 2 of this form and send to International Education & Programs,
Elgin Community College, 1700 Spartan Drive, Elgin, IL 60123 USA.
Elgin Community College SEVIS School Code: CHI214F12510000
Section 1 (To be completed by the STUDENT)
1. Name:
Middle Other
2. ECC Student ID Number: 3. Date of Birth: / /
Month Day Year
4.
5. Term of admission at ECC: Year:
6. I verify that the above information is correct, and authorize my current school to provide the information requested.
/ /
Month Day Year
Section 2 (To be completed by DSO at transfer-out school)
Note to DSO: Please do not transfer student’s SEVIS record until student’s admission to ECC is conrmed.
To the best of my knowledge, this student is in valid F-1 status and is eligible for transfer.
Has the student been authorized for a reduced course load in SEVIS?
If yes:
Has the student been authorized for practical training?:
If yes: CPT OPT Dates:
What is the student’s last date of enrollment (or OPT) at your school?
/ /
/ /
Month Day Year
Student’s SEVIS ID Number: Transfer Release Date:
Month Day Year
The student is out of status and has been advised to discuss reinstatement with ECC.
Title of DSO
School’s Name:
School’s Address:
Email:
/ /
Month Day Year
15 International Student Application for F-1 Students, Elgin Community College
