Montgomery College
International Student Office
F-1 TRANSFER CLEARANCE / CERTIFICATION FORM
This form AND “Release” of access to the SEVIS I-20 data record is required to issue a form I-20
Section I - Student must complete and SIGN this section.
I give permission for the information requested below to be sent, to Montgomery College, ___________________________________.
Name of Campus
________________________________________________________________________________________________________________________
Last Name / Surname(s) First / Given Name(s) Country of Citizenship
________________________________________________ Month ____ Day ____ , Year 20 ____ . ______________________________________
Student’s Signature MC Student ID number - If known
Will you TRAVEL OUT OF THE UNITED STATES BEFORE ENROLLING AT MONTGOMERY COLLEGE? : ☐ Yes ☐ No
Section II - To be completed by the current or former school’s DSO (international student advisor)
1. Is this student eligible for In-status transfer in the SEVIS system? : ☐ Yes ☐ No (please explain in #7)
2. Student’s Last “Seat Date” (End of attendance or Authorized Vacation Or OPT)? : ____________________________________
3. Has this student had financial difficulties while attending your institution? : ☐ Yes ☐ No
(if yes, please provide name of sponsor) ________________________________________________________________________
4. Has this student ever been granted approval to enroll less than full-time? : ☐ Yes ☐ No
Dates __________________________ Types___________________________ Educational Level___________________________
5. Authorized Practical Training: Type _____________________________ Educational Level: _____________________________
Dates __________________________________________________________________________________________________________
6. Sevis Release Date**: ________________________________________ Sevis ID #: ______________________________________
**Please release sevis record only upon proof of acceptance to montgomery college. An acceptance letter will be
provided directly to the student only after admission to the college and after receipt of this form.
7. Additional Comments: (if needed you may use the back of this form)
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
Signature of Designated School Official Title Date
________________________________________________________________________________________________________________________
Printed or Typed name of Designated School Official Email Address
________________________________________________________________________________________________________________________
Name and Location, City, and State of School Phone Number
Section III - Designated School Official PLEASE fax or mail this form to the Campus noted by the student above –
attention: “International Student Coordinator” or EMAIL to I20questions@montgomerycollege.edu
