International Student
Transfer Clearance
(school code: BOS214F10329000)
All students applying to Manchester Community College currently on an F-1 Visa must present this form to the Designated School Official (DSO)/Principal Designated School
Official (PDSO) of their current school for completion.
Complete this form and return to the International Student Affairs office, SSC room L156, or mail to MCC International Student Affairs, MS #12, P.O. Box 1046, Manchester
CT 06045-1046. For more information, call 860-512-3204 or email ma-international@manchestercc.edu.
STUDENT INFORMATION
First Name MI Last Name SEVIS ID Number
STUDENT ATTENDING SCHOOL/DSO INFORMATION
Name of School
Street Address
City State Zip
DSO/PDSO First Name DSO/PDSO Last Name
Phone Email
STUDENT ACADEMIC INFORMATION
Academic Program Number of Credits Completed
Dates of Attendance Is the student in good academic
standing?
n
Yes
n
No
To the best of your knowledge is the student
maintaining full-time status?
n
Yes
n
No
Is the student eligible to continue at
your institution?
n
Yes
n
No
Does the student have outstanding financial
obligations at you school?
n
Yes
n
No
Is the student compliant in
SEVIS status?
n
Yes
n
No
SEVIS Release Date
REQUIRED
DSO/PDSO Signature Date
The student must sign this form or it will not be processed.
Student Signature Date
February 2020/PR
MI
