08/21/20
International Student Office
2600 Mission Bell Dr, San Pablo, CA 94806
Phone: 510.215.3954 or 510.215.3922.
Email: larentz@contracosta.edu
Transfer-Out Request Form
Stude
nts who are received an acceptance letter to transfer to another U.S.
college/university must complete the following:
q Transfer-out Request Form
q Attach a copy of acceptance letter with the SEVIS school code for transfer
STUDENT INFORMATION:
Legal Name:__________________________________________________________________
Surname/Family Given Names
CCC
ID#: ___________________________ Date of Birth (DOB): _____________________
Month / Day / Year
Email Address: __________________________________________
SEVIS ID: ___________________________________
TRA
NSFER INSTITUTION INFO:
Transfer Term & Year (ex. Fall 2017): _______________ SEVIS Transfer Release date: ____________________
College/University name: ______________________________ Ma
jor: ________________________________________
Are you traveling outside of the U.S. during the break before you attend the transfer college/university?
q No.
q Yes. If yes, you must contact your transfer college/university adviser to in order
receive your I-20 before you travel.
By signing below, I am requesting my SEVIS ID number be transferred to the college/university listed above.
_____________________________________________" ____________________"
Student Signature Date (Month/Day/Year)
OFFICE USE ONLY: SEVIS School Code: ___________________________________
q Zero Balance
q In-Status
q Transfer Date: ___________________________
q DSO Initials: ____________________________
