INTERNATIONAL STUDENT FORMS:
Program Extension Request
As an international student in F-1 visa status, you may not study in the U.S. past the program end date listed on
your I-20. If your I-20 will expire and you need more time to complete your studies, you may request a
program extension from your advisor.
If your program end date has already passed, you are no longer in lawful F-1 status.
Program extensions are approved only for compelling medical reasons or compelling academic reasons. Failure
to maintain satisfactory academic progress, academic probation, and academic suspension are not valid reasons
for a program extension. Program extensions may be requested for up to 12 months maximum.
Student Name: _________________________________________
Student ID#: _________________________________________
SEVIS ID#: _________________________________________
Current Program End Date: _______________________________
Requested Extended Program End Date: _____________________
Reason for Extension:
Documented illness (please include documentation if not already on file)
Change of major
Previous major: ________________________________
New major: ___________________________________
Other compelling academic reason (please explain):
Please note: Academic probation/suspension is not a valid reason for a program extension.
Student Signature: ______________________________________ Date: _________________________
Advisor Signature: ______________________________________ Date: _________________________
Office Use Only
Program Extension:
Approved
Denied
Recorded in SEVIS on (date): ___________________________________
New I-20 given to student on (date): ______________________________
SPACMNT note
updated 2/27/2015
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