Office of International Student Program
1600 W. Imperial Hwy Los Angeles, CA 90047 www.lasc.edu (323) 241-5278
Page 1 of 1 Updated 07/10/2020
Transfer Eligibility Form
The student has applied for admissions to Los Angeles Southwest College. This form is used to determine admission
eligibility to LASC. Please complete this form and return to the International Student Program. Do not transfer the
student’s SEVIS record until your school has verified student’s acceptance to LASC.
To Be Completed by the Student
Last Name: ______________________________________ First Name: ___________________________________
Date of Birth: _____________ SEVIS ID Number: ____________________ Phone Number: __________________
Email Address: ________________________________________________________________________________
To Be Completed by School Transferring From
Current School Name: ___________________________________________________________________________
Address: ______________________________________________________________________________________
Phone: _________________________________ Email: ________________________________________________
Student’s Major: _______________________________________________________________________________
Date First Attended: ___________________________ Current Session End Date: ____________________________
Is the student in-status according to F-1 visa regulations? • Yes • No
If no, please explain: _____________________________________________________________________
Has the student ever received approval for a Reduced Course Load? • Yes • No
Has the student had Curricular Practical Training (CPT)? • Yes • No
If yes, please provide dates: ________________________________________________________________
Has the student had Optional Practical Training (OPT)? • Yes • No
If yes, please provide dates: _________________________________________________
Does the student currently have any outstanding financial obligations at your school? • Yes • No
Has your institution ever taken disciplinary action against this student? • Yes • No
If yes, please explain: ____________________________________________________________________
Designated School Official’s Signature: _____________________________________ Date: ___________________
Designated School Official Printed Name and Title: ____________________________________________________