Fillable Transfer Eligibility Form This form must be completed (Dickinson State University)

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Transfer Eligibility Form This form must be completed (Dickinson State University)

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The Transfer Eligibility Form This form must be completed (Dickinson State University) form is 2 pages long and contains:

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  • 12 check-boxes
  • 26 other fields

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Transfer Eligibility Form
This form must be completed by all F-1 students intending to transfer to Dickinson State University from a high school,
English language school, college or university within the United States. To be completed by the STUDENT.
______________________________________ ______________________________________
Last Name (as listed on passport) First Name (as listed on passport)
______________________________________ ______________________________________
Date of Birth Country of Origin
______________________________________ ______________________________________
SEVIS Number Email Address (as listed in SEVIS)
Foreign Permanent Address: __________________________________________________________________________
__________________________________________________________________________________________________
Will you be travelling outside of the United States before enrolling at Dickinson State University? YES NO
If yes, will you need to apply for a new visa? YES NO
Usually only necessary if your current F1visa has expired.
U.S. Address (required):
__________________________________________________________________________________________________
Please mail my transfer I-20 to the following address:
__________________________________________________________________________________________________
I authorize the school named below to provide the information requested on this form in order for Dickinson State
University to process my application for admission and for issuance of form I-20.
______________________________________ ______________________________________
Student’s Signature Date
SEVIS Transfer Eligibility Form
To be completed by the CURRENT or FORMER SCHOOL’S PDSO/DSO.
_____________________________________________________________________
Student’s Dates of Attendance (Month/Year to Month/Year)
______________________________________ ______________________________________
Type of Visa (F-1, M-1, etc…) Dates of authorized, full-time CPT
______________________________________ ______________________________________
Dates of pre-completion OPT Dates of post-completion OPT
______________________________________ ____________________________________________________
Dates of authorized Reduced Course Load Reason for Reduced Course Load
Is the student currently in status? YES NO
If no, please explain: ________________________________________________________________________________
Has the student ever applied for reinstatement? YES NO
If yes, please explain: _______________________________________________________________________________
Is the student in good academic standing at your institution? YES NO
Is the student in good financial standing at your institution? YES NO
Please have the student’s SEVIS file transferred to Dickinson State University. (SEVIS Code: SPM214F00268000)
______________________________________
Transfer Release Date:
______________________________________ ______________________________________
Name and Title of School Official (PDSO/DSO) Signature
______________________________________ ______________________________________
School Name Phone Number or Email Address
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Transfer Eligibility Form This form must be completed (Dickinson State University)

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Completed 29 January 2021

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