International Student Office
2600 Mission Bell Dr, San Pablo, CA 94806
Phone: 510.215.3954 or 510.215.3922.
Transfer-Out Request Form
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
Surname/Family Given Names
ID#: ___________________________ Date of Birth (DOB): _____________________
Month / Day / Year
Email Address: __________________________________________
SEVIS ID: ___________________________________
NSFER INSTITUTION INFO:
Transfer Term & Year (ex. Fall 2017): _______________ SEVIS Transfer Release date: ____________________
College/University name: ______________________________ Ma
Are you traveling outside of the U.S. during the break before you attend the transfer college/university?
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 Transfer Date: ___________________________
q DSO Initials: ____________________________