Center for International Education
Northern Arizona University
PO Box 5598
Flagstaff, AZ 86011-5598
Phone: (928) 523-2409
SEVIS Transfer-In Verification Form
This form is required of all F-1 or J-1 international students admitted full-time to Northern Arizona University and who are
currently enrolled at another U.S. school/college/university OR are in a period of Post-Completion Optional Practical
Training (OPT) or Academic Training (AT).
A student cannot be issued a Certificate of Eligibility (I-20 or DS-2019) from Northern Arizona University until this form is
completed in full, the SEVIS record release has been scheduled, and the transfer release date has passed.
If student needs to travel out of the country and plans to return after the SEVIS release date, please be aware that he/she must
be in possession of an I-20 or DS-2019 form issued by Northern Arizona University and a valid visa.
Part 1: To be completed by the STUDENT:
*Name should be written as shown on your government issued passport.
Family Name:___________________ First Name:____________________ Middle Name:__________
NAU Student ID #: _______________ Date of Birth:______________ SEVIS ID #_______________
I-20 Shipment Information (through Federal Express): ____________________________________________
(Street Address)
(City) (State) (Zip code)
(Phone Number at this address)
Address Effective Until: ______________________
(Month Day Year)
I hereby authorize the Designated School Official (DSO/ARO) to provide the information below to NAU.
Student Signature:_________________________________ Date: ________________________
Part 2: To be completed by the international advisor (DSO/ARO):
The above named student intends to transfer to Northern Arizona University. Please email a copy of this form to our office
at: Our SEVIS code is: PHO214F00090000 / our program # is: P-1-04989.
To the best of your knowledge, is the student named above in status according to United States
Department of Homeland Security regulations and eligible for transfer?
Yes______ No_______ (Please note, NAU does not accept completed OR terminated records)
Is the student currently on OPT? Yes____ No____
SEVIS Transfer Date: _______________________
DSO/ARO: I certify that the above information is valid and correct:
Name: __________________________________Email Address: ______________________________
Institution: ______________________________________ Phone Number: _____________________
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