Program Extension Application - Doctoral Students
for F-1 International Students
Office of International Student ServicesLiberty University, 1971 University Blvd., Lynchburg, VA 24515
Phone (434) 592-4118Fax (434)
Updated 12/21/2017
General Information: An F-1 student who is unable fulfill all degree requirements before the “program end
date on the Form I-20 may be granted an extension by the International Student Advisor (ISA). To qualify, the
ISA must certify that the student has continually maintained status and that the delays are caused by compelling
academic or medical reasons, such as changes of major or research topics, unexpected research problems, or
documented illnesses. Delays caused by academic probation or suspension are not acceptable reasons for
program extensions. The ISA may not grant an extension if the student did not apply for an extension before the
program end date noted on the Form I-20.
1. An approval signature from the Director/Dean of the department.
2. An approval signature from the Embedded International Student Accounts Representative.
3. All students must be registered and financially checked in for the following semester and submit a
Doctoral Registration Form.
4. Updated Degree Completion Plan Audit (please print this from your ASIST account).
5. A bank statement proving funding for the additional semester(s). Must be sufficient to pay for tuition,
fees, and housing per USCIS regulations. Amount is determined by the financial information on your I-
20. *Note: if the bank statement is not in the student’s name, an accompanying sponsor letter must be
To be completed by the student:
Name: Student ID #:
Program of Study: ____________________________________________________________________
Please provide a brief explanation of why you did not complete your degree by the Program End Date:
Student Signature: Date: ____/____/_____
To be completed by Director/Dean of Program
Name and Title: ______________________________________________________________________
Phone: (______) - ______-_________ E-mail_______________________________________________
Date to which the extension will be granted ____/____/_____
By signing this form, I confirm that my department is able to provide a minimum of 6 total credit hours (including
no less than 3 credits of residential studies) for each of the remaining fall and spring semesters. For programs
that do not operate on a semester basis, you must guarantee no less than 6 credits in any given 6-month period,
with the “period” being defined by the span between July 1-December 31, and January 1-June 30. At least one
residential course must be taken during the spring semester (JAN-MAY) and the fall semester (AUG-DEC).
Signature: Date: ____/____/_____
To be completed by the Embedded International Student Accounts Representative:
Signature: Date: ____/____/_____
**Return this completed form and required documents to your International Student Advisor for
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