OFFICE OF INTERNATIONAL
ADMISSIONS AND RECRUITMENT
SEVIS TRANSFER ELIGIBILITY FORM
FOR INTERNATIONAL (F-1) STUDENTS
Students in F-1 immigration status transferring from another U.S. institution to Palm Beach State College (PBSC) must complete this form
as part of the admission process. The Office of International Admissions at PBSC must receive this completed document
before issuing the Certificate of Eligibility (I-20).
SECTION A – To be completed by Student
Last Name (Family/Surname) First Name (Given Name) Middle Name
Expected Semester of Entry at PBSC: /
SEVIS ID Number Semester Year
I give consent to my current institution to release the requested information mentioned below to the Office of International Admissions at
Palm Beach State College.
Date: _/ /
Student’s Signature
SECTION B – To be completed by Designated School Official (DSO)
SEVIS Release Date: / / Student’s last semester of enrollment at your institution:
To the best of your knowledge, is the student currently in-status? □ Yes □ No
Was the student ever granted practical training? □ Yes □ No If yes, please specify: □ OPT □ CPT
Would you accept the student back to your institution? □ Yes □ No (If no, please explain)
School/Name and Mailing Address
Email (PDSO/DSO) Phone
/ /
Name and Title of PDSO/DSO (please print) Signature Date
Please submit completed form to:
Rev. 03/20/17
Office of International Admissions and Recruitment
Palm Beach State College
4200 South Congress Avenue
Lake Worth, Florida 33461-4796
Phone: (561) 868-3029 Fax: (561) 868-3623
Email: international@palmbeachstate.edu
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