NEO International Student Program
School Transfer Certification - Incoming
[For students transferring from a different U.S. College/University to NEO A&M College]
Section 1 To Be Completed By the Student applying to NEO A&M College
Name: ____________________________________________________________________________
[Last] [First] [Middle]
Mailing Address: _______________________________________________________________
Home Phone: [ country code ] ________________ [ number ] ________________________________
Cell Phone: [ country code ] ________________ [ number ] ________________________________
Email Address: ______________________________________________________________________
Gender: Male Female Date of Birth (Month/Date/4 Digit Year): ______ / _____ / _____
City of Birth: _________________________________________________________________________
Country of Birth: ______________________________________________________________________
Country of Citizenship: _________________________________________________________________
_________________________________________________________________________________________________
Signature of applicant Date:
Section 2To Be Completed By the International Student Advisor at the College Where the Applicant is Currently Enrolled
Please answer the following questions regarding NEO International Program
the student named above and return this form to: 200 I Street NE
Miami, OK 74354
Name: ____________________________________________________________________________
[Last] [First] [Middle]
INS Number: ________________________________________________________________________
Type of Visa: ________________________________________________________________________
Completion date on Current I-20 form: ____________________________________________________
Please check all the appropriate statements:
This student is in status with all INS regulations
This student is out of status and a reinstatement was filed on _________________ and is pending.
(Please attach documentation of reinstatement request.)
This student is out of status and must apply for reinstatement.
This student is eligible for re-enrollment.
Name of Institution: _____________________________________________________________
Name and Title of DSO: _________________________________________________________
Email of DSO: _________________________________________________________________
Institution Mailing Address: _______________________________________________________
_____________________________________________________________________________
Phone number: ________________________________________________________________
“I hereby certify that the above information provided is true and accurate.”
_______________________________________________________________________________________________
Signature of applicant
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