1) Complete top portion of this form.
2) The international student advisor at your current school completes the bottom portion and emails a scanned copy of this
completed form to
To be Completed by Student
Name: Birthdate:
Current student ID number: School/Dept:
Degree sought at ENMU:
I hereby grant permission for the information requested to be forwarded to ENMU.
Student signature Date
To be Completed by Designated School Official (DSO) or Alternate Responsible Officer (ARO)
In accordance with USCIS regulations, we request that you complete the following section and email a scanned copy to so we may transfer the students SEVIS record. Please transfer the record to Eastern New Mexico
University, school code ELP214F00300000: Ofce of International Programs
ENMU Station 2
1500 S Ave K
Portales, NM, 88130
What is the student’s nonimmigrant status? q F-1 q J-1
If J-1 please provide: Program number: Sponsor:
Length of time in the U.S.
Category marked in Number 4 on the DS-2019 form?
To the best of your knowledge, is this student in good standing based on CIS (formerly INS) regulations? q Yes q No
If no, please explain:
Student’s SEVIS ID? Student’s SEVIS transfer release date?
Is the information above completed by the student correct? q Yes q No
What semester/quarter did/will the student last complete study at your institution?
Institution name: Phone:
Institution mailing address:
City State ZIP
DSO or ARO printed name DSO or ARO signature Date
WN1112 • 12/17
International Student Transfer
Oce of International Programs | ENMU Station 2 | 1500 S Ave K | Portales, NM 88130
Administration Building (ADM), Room 216 | Phone: 575.562.4698
International Programs