California State University, Sacramento
International Programs and Global Engagement
6000 J Street, Library 1001
Sacramento, CA 95819-6012 USA
T (916) 278-6686 F (916) 278-7471
R E Q U E S T F O R
PRO GRAM
E X T E N S I O N
REQUIRING DEPARTMENT
APPROVAL
A request for a program extension must be authorized by the
academic advisor and IPGE before a student’s program and I-20 can be
extended. Immigration regulations allow program extensions for
students maintaining status and making normal progress toward
completing educational objectives. The student is responsible for
obtaining a program extension prior to I-20 expiring. If a program
extension is not authorized prior to I-20 expiring, than the student will
be out of status and must file for reinstatement.
Name:
Date:
E-mail: Sac State ID: Phone:
Graduate SEVIS Number:
Degree Objective: Undergraduate
Current Visa status: F-1
J-1
To be completed by program advisor:
Student’s academic program (major):
Requested extension of (choose one):
1 semester 1 year
Expected program completion/graduation date:
Reason(s) for delay in program completion (please check all that apply):
Change of major
Unavailability of courses
Change in research topic
The original allotted time for study (on I-20 or DS-2019 document) is not sufficient
Medical reasons (medical documentation from a medical practitioner must be attached)
Other reason(s), please specify below:
I hereby recommend additional time for student to complete his/her program.
Advisor Name: Advisor Signature:
Date: E-mail: Phone #:
For IPGE Use Only:
Petition Approved: Petition Denied: Date:
Staff Initials:
