Applicants transferring to Midlands Technical College from another school must have this form completed by the International Student Services
Oce at the school you are leaving. The form must then be submitted to the International Student Services Manager at Midlands Technical
College by the International Oce designee.
Applicant:
Sign this form giving your permission to send the information requested to Midlands Technical College as part of your application for admission.
Give the form to the International Student Advisor at your college to complete. If you need more than one form, make a photocopy.
I authorize the release of the information requested on this form to Midlands Technical College.
Last Name First Name Middle
Signature of Student Date
Student Number at your Current School
International Student Advisor:
All information on this form will remain confidential and will be used only in conjunction with the student’s application for admission to Midlands
Technical College.
STUDENT’S SEVIS ID:
Dates of attendance at your institution : From To
mm/dd/yyyy mm/dd/yyyy
Did the student consistently maintain a full course of study?
If not please explain:
Is/Was the student in good standing with USCIS while they attended your institution?
If the student was not in status with USCIS, please provide details.
Name of International Student Advisor Name of Institution
Street Address (include apt. #) City State Zip Code
Email Address of Student Advisor
Signature of International Student Advisor Date
After you have completely filled in the above information you can scan the form and email it to jensenp@midlandstech.edu or send by mail to
the Admissions Oce at the address listed below.
INTERNATIONAL STUDENT OFFICE
TRANSFER STATUS VERIFICATION FORM
MIDLANDSTECH.EDU | ADMISSIONS OFFICE | PO BOX 2408 | COLUMBIA SC 29202 | 803.738.8324
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