This section to be completed by the student:
I, ________________________________________________________________________________, presently residing at
______________________________________________________, ___________________________________________
(Street address) (City) (Zip code)
plan to attend Norwalk Community College beginning _______________________________________________ semester.
I authorize my current school, ________________________________________________________, to release information
(Name of school)
concerning my F1 status and request that the letter of acceptance together with this transfer form be emailed to my current
international advisor,_____________________________ at this email address: ___________________________________.
Student’s signature: ___________________________________________ Date: ________________
This section to be completed by the current International Student Advisor:
Student’s SEVIS ID ___________________________________ SEVIS release date______________________
_____The student is in a valid F-1 status and eligible to transfer
_____The student is out of status (please DO NOT transfer the record)
_____Other (please specify): ________________________________________
Please list all previous authorized periods of practical training:
Curricular: from ______________________to _______________________ Part-time/Full-time_______________
Optional: from ______________________to________________________ Part-time/Full-time_______________
Norwalk Community College is listed as “Norwalk Community College” in SEVIS (BOS 214F10319000).
____________________________________ ________________________________
Name of Designated School Official completing this form Signature
___________________________________________ ________________________________________
Name of School Telephone Number
Please email completed to: or mail to:
International Student Services Center, rm. 202E
Norwalk Community College
188 Richards Avenue
Norwalk, CT 06854
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