Name: ____________________________________________________________________________
[Last] [First] [Middle]
INS Number: ________________________________________________________________________
Type of Visa: ________________________________________________________________________
Completion date on Current I-20 form: ____________________________________________________
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: _________________________________________________________________
“I hereby request that my SEVIS record be transferred to the school listed below.”
_________________________________________________________________________________________________
Signature of applicant Date:
Transfer for the ☐ Fall Semester ☐ Spring Semester of ______________ (Year)
The date on which the transfer should be processed: __________________________________
[ Note: Be 100% sure you have the approval of the International Student Coordinator at your NEW school when selecting this date. A transfer can’t be
reversed by NEO once processed in SEVIS. If your new school does not accept your record within the transfer period it is auto-terminated by SEVIS. ]
Name of Institution: _____________________________________________________________
Name and Title of DSO: _________________________________________________________
Email of DSO: _________________________________________________________________
Institution Mailing Address: _______________________________________________________
_____________________________________________________________________________
Phone number: ________________________________________________________________
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
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.
“I hereby certify that the above information provided is true and accurate.”
_______________________________________________________________________________________________
Signature of DSO @ NEO A&M College
