International Student Transfer Form
Advising and International Programs - Arapahoe Community College
5900 S. Santa Fe Drive - Littleton, CO 80160-9002
Email: international@arapahoe.edu
SEVIS Code: DEN214F00239000
Part I. (To be completed by the international student)
_____________________________ _________________________ ______________
Last name First name Middle name
_____________________________ _______________________ ________________
SEVIS # Country of Citizenship I – 94 #
_________________________ ______________ ____________________________
Social security number (if applicable) Phone number Birth date
I hereby authorize the International Student Advisor (or equivalent school official) to provide the
information below as part of my application to ACC.
______________
Date
________________________________________
Student Signature
Part II. (To be completed by International Student Advisor)
Please check and complete all that apply:
This student i
s in good standing and is/was enrolled in a full course of study from ____________
until ___________.
This student i
s out of status and a reinstatement to student status was filed on (date) ___________ with
USCIS in (location) ________________ and is pending.
This student i
s out of status and must file for reinstatement. Include explanation.
This student has
previously been granted practical training; please specify type(s) and dates.
_________________________________________________________________________________
Other (or comments):______________________________________________________________________
__________________________________________ ___________________________________________
DSO Signature DSO Name
__________________________________________ ___________________________________________
DSO Title School Name
__________________________________________ _____________________ _____________________
School Address City/State/Zip Date
__________________________________________ _____________________ _____________________
DSO Email Address Phone # School SEVIS Code
TRANSFER OUT DATE ____________________
Revised 10.28.2019
