International Student Services
I-20 Program Extension Request Form | 651.779.3300
3300 Century Avenue North, White Bear Lake, MN
International students are given a specific time frame in which to complete their degree program. The exact dates
are listed as “program start/end date” on the I-20. There are often valid reasons that a student is unable to finish a
degree by the date noted on the I-20. If this is the case, the student is required to apply for an I-20 Program
Extension with their Academic Advisor.
An international student is eligible for a program extension if:
The student has continually maintained status per USCIS and Century College regulations.
The delay in program completion is caused by compelling academic or medical reasons, such as changes of
major, need for additional developmental courses, or documented illnesses.
The student applies for an extension PRIOR TO the program end date. (I-20s cannot be extended after the
program end date and the student will be considered out of status with USCIS.)
1. Meet with your Academic Advisor one semester BEFORE your I-20 expires. This will allow enough time to
determine if you are eligible for an extension or to make other plans.
2. Fill out the form below and create an academic plan with your Academic Advisor.
3. Submit the form directly to your Academic Advisor. If approved, you will be issued a new I-20.
Part 1. To Be Completed by the Student: Please Type or Print Clearly
Student Name: _______________________________________________________________________________
Student ID: ____________________ Phone:__________________ Email_________________________________
Degree Program: _________________________________ I-20 Expiration Date: __________________________
By signing below, I certify that I am requesting a program extension on my I-20. I certify I have sufficient funds
available to pay all of my necessary expenses for the duration of my studies at Century College.
_________________________________________________________________ _______________________
Student Signature Date
Century College is a member of Minnesota State. We are an affirmative action, equal opportunity employer and educator. This document
can be available in alternative formats to individuals with disabilities by calling 651.773.1745 or emailing
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Updated 12/04/19 | 651.779.3300
3300 Century Avenue North, White Bear Lake, MN
Part 2. To Be Completed by the Academic Advisor:
The reason the student has not completed their degree program is: (check all that apply)
Delay caused by change of program major
Delay caused by need for additional developmental courses
Delay caused by documented illness
Other (please explain briefly)_______________________________________________________________
_________________________________________________________________ _______________________
Academic Advisor Signature Date
_________________________________________________________________ _______________________
Academic Advisor Name (please print) Phone
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