Updated 07/02/20 CK
Please Release My SEVIS Record to
Monroe College, New Rochelle, NY
SEVIS CODE: NYC214F00936001
* * * * * TO BE COMPLETED BY YOU, THE STUDENT * * * * *
Last Name: _________________________________________________ First Name: _______________________________________________ Monroe ID #__________________
Street Address: ____________________________________________ City: _______________________________ State: ____________________ & Zip Code ______________
(include your apartment #)
Personal Email Address: ___________________________________________________________________ Phone Number: _______________________________________
SEVIS Number (top left corner of I-20): N_____________________________________________
For which semester have you been accepted to attend Monroe College?
Check one: _______Fall/September 20____ _______Winter/January 20____ _______Spring/April 20_____
Any current OPT or CPT will end immediately upon the release of your SEVIS record.
Please release my SEVIS record to Monroe College on this date: _______________________________________________
MM/DD/YYYY
PLEASE NOTE: As per USCIS regulations you must complete the transfer process within 15 days of the program start
date at Monroe College. Failure to do so will deactivate your SEVIS (I-20) record and you will no longer have valid
student status.
Student Signature: ______________________________________________________________________________________ Date: _________________________________
* * * * * * TO BE COMPLETED BY AN ADVISOR AT YOUR CURRENT SCHOOL * * * * * * *
Once completed please scan this form to ckerr@monroecollege.edu or fax to 914-813-1269. Thank you!
School Name: ________________________________________________________________________________________________________________
Dates of attendance at your school: Start Date: __________________ Last Day Attended: _________________
MM/DD/YY MM/DD/YY
Student has been enrolled in a full-time course of study and is in valid F-1 status.
❑ Student is currently on OPT. OPT authorization period: ___________________ to ___________________
❑ Has the student met all financial obligations to your school? Yes _______ No _______
❑ If the student is not in valid F-1 status please indicate current status: __________________________________
Comments: __________________________________________________________________________________________________________________
SEVIS release date for above-named student: ____________________________________________________________________________
MM/DD/YYYY
Advisor Name: _________________________________________________ Advisor Signature: ____________________________________________ Date: __________________
Advisor Email Address: ______________________________________________________________ Advisor Phone Number: _________________________________________
