DSO:%Please%return%completed%form%to%student%and%have%them%email%the%form%to%their%Centenary%College%Adm issions%Officer.%Th is%fo rm %m u s t%be %
received%before%an%I-20%can%be%issued%for%their%attendance%at%Centenary%College%of%Louisiana.%
%SEVIS%Tr ans f er%F orm%(f or%F-visa%holder s)%
BIOGRAPHICAL%DATA%(to%be%comp leted %by%stu d en t)%
Surname/Last%Name%(as%appears%on%passport)% First/Middle%Name%(as%appears%on%passport)%
Email%Address%
.%
Current%US%Resident%Address% .%
SEVIS%ID%Number%%%%%% Centenary%ID%Number%%%%%%
Requested%SEVIS%Release%Date%%%%%%% Current%Program%End%Date%%%%%%%
Are%you%currently%in%compliance%with%your%visa%status?% Yes% %No
I%request%a n d %a u th o rize %my%current%D e s ign a te d %S ch o o l%Official%(or%equ iv a len t %o ffic er )%to %p ro v id e %th e %in fo rmation%requ e s te d %b elow%as%
part%of%my%application%to%Centenary%College%of%Louisiana.%% % % % %Yes% %No%
Student%Signature%
Date%%%%%%%%%%%
%
ACADEMIC%DATA%(to%be%com ple ted %by%cu rren t%De sign a ted %Sch oo l%Officia l %[D S O ]%or%Alternate%Responsible%Officer)%
CPT/Academic%Training%
FROM:%%%%% TO:%%%%%
CPT/Academic%Training%
FROM:%%%% TO:%%%%
Pre/Optional%Practical%Training/AT%
FROM:%%%% TO:%%%%%
Post/Optional%Practical%Training/AT%
FROM:%%%% TO:%%%%%
Reduced%Course%Load%
FROM:%%%% TO:%%%%
Reduced%Course%Load%for%Medical%Reasons?%
Yes% %No
Is%this%student%currently%in%compliance%with%F%
status?%
Yes% %No
Is%this%stud en t %cle a re d %o f%a ll%in st itu tio n a l%fin a n cia l%
obligations?%
Yes% %No
Name%and%Address%of%Current%School%
DSO/ARO%Email%Address%
.!
DSO/ARO% Telephone%
Number%.%
Name%of%DSO/ARO%
%
DSO/ARO%Signature%
Date%
.%
This%form%i s%to%be%completed%by%the%F-1%visa%holder%and%signed%by%the%previous%school’s%Designated%School%Official%prior%to%requesting%that%the%
student%SEVIS%record%be%released%to%Centenary%College%of%Louisiana%(campus%code:%NOL214F00083000).%
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