PCC ID#: _
No Yes
______________
(last 8 digits)
SEVIS ID#: N00 ___________________
Which semester will you begin at your new school?
___________
SEVIS Record Release Date:
_________
Semester Year
Name of your new institution (SEVI nS ame) :____________________
School SEVIS Code:
_________________________
City and State:
Are you currently on OPT(Optional Practical Training)? If Yes, EAD expiration date:
_______________
If transferring to a language school or other community college, please provide reason for transfer
:
_________________
mm/dd/yyyy
mm/dd/yyyy
_____________
_______________
_________________
________________________________________________________ ____________________________
F- 1 Student Transfer-Out Request Form
If you are going to transferto another SEVIS school you must complete this form and sign the release statement below.
Please Note: ISC will release your record only when we receive this form and a copy of an acceptance letter from the school
you will be transferring to. If transferring to a University, you will be required to fill out a graduation petition form upon
submittng this request. The petition forms are available at ISC.
Student to complete:
Student Name: ________
______________ ______________________ _________
Family Name First Name
MI
Date of Birth:
____________
Phone#:
_______________
PCC Email
:
_______________
@go.pasadena.edu
mm/dd/yyyy
Major: ________________ First Semester at PCC: ___________ Expected Graduation:
(If applicable)
semester/year semester/year
Program End Date on I-20: _________ Passport Expiration Date: __________ Visa Expiration Date:
__________
mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy
Important Notes:
•If your plans change and you decide to transfer to a different school, or if you will not transfer at all, it is very important that you
tell the Interna· onal Student Center BEFORE your release date. We will be able to release you to a different school, or pull your
records back to PCC as long as you contact us before the release date. If you contact us with changes a· er the release date, we will
no longer have access to your immigration records and will not be able to make the changes that you request. You will have to
contact the new school.
•You are responsible for dropping all of your PCC courses. Please check the refund deadlines to determine whether or not you will
receive a refund for the dropped courses.
I have read and understood the informaon above and my responsibilies. I state that the informaon I provided on this form is true.
Student Signature mm/dd/yyyy
ISC staff to complete:
SARS
Request log
Transfer within 5 months?
Email student Email A&R
Acceptance letter SEVIS
Initial: ___
___ Date: _________
Important Note: All paperwork requests require 10 business days to process.
1570 East Colorado Blvd. D-204 • Pasadena, CA 91106-2003 • (626) 585-7808 • iso@pasadena.edu
revised 4/25/2018
