December 2019
Student Information
Name (in passport): Date of Birth:
Last First
Phone: Cascadia Student ID #:
Email:
Local Mailing address:
Signature: Date:
Reprint I-20: Reason Lost Stolen Damaged Updated Other _________________
Change of Degree or Major: From: ___________________________ To:_______________________________
Program Extension: Reason ____________________________________________________________________
From (Quarter): __________________________ To:
Reduced Course Load:
Quarter & Year: Fall / Winter / Spring / Summer Year: ____________________
Reason: (check one and submit additional info as noted):
o Graduating quarter – Submit copy of degree audit / updated education plan
o Medical reason – Talk to the International Student Advisor for details. Submit a doctor’s note.
o Concurrent enrollment – Please attach your course schedule from the other school.
o Initial academic difficulty (first quarter in U.S. only) – Talk to the International Student Advisor for
details).
Vacation quarter:
My I-20 expires on ______/______/______ (mm/dd/yy)
My SEVIS ID is N __________________________.
I am requesting a vacation quarter during _______________Quarter, 20_______.
I will return to Cascadia and enroll full time for ________________Quarter, 20________.
If you are transferring to a different school at the end of the vacation quarter do not complete this form.
To be completed by the International Programs Office
Advisor’s Initials Advisor’s Signature Date
□ Approved □ Denied □ Scan and e-file □ Email student □ Update database □ Update SMS □ Update SEVIS
Cascadia College is an equal opportunity institution and does not discriminate on the basis of race, color, religion, gender and/or sex, disability, national origin,
citizenship status, age, sexual orientation, veteran’s status, or genetic information. All Cascadia materials are available in alternative formats and can be requested by
contacting the Human Resources office.
