TransferIn
Fo
rm
StudentscurrentlyintheUS on an F-1 visa and admitted to an undergraduate or ESL program at Michigan Tech should
complete and submit this form to the Admissions Office by email at mtu4u@mtu.edu.
First
Name
To
be
CompletedbyStud
ent
Mailing
Address
City
State
 ZipCode
Telephone
Transfer
Semester
Fall Spring
Signature Date
To
be
Completedbya DSO at your Current School
1. Whatisthecurrentstatusofthisstudent?
Studentdidnotreporttothisschool
Studentreportedtothisschool,butdidnotcomplete
registration
oratt
en
dclass
Studentiscurrentlyenrolledina
fulltime
program,andhasbeenenrolledsince
Studentbeganstudyinginthis
progr
a
m
on andcompleted
the
course
ofstudyon
Studentdidnotcompletethecourseofstudy. His/herlastdayofattendance was
Studentisinreinstatementorchangeofstatusproceedings,theSRCnumber,ifknown,is
Other
 ____________________________________________________________________________
2. Doesthestudenthavedependents? Yes No Ifyes,howmany?_______________
Transfer
Rel
ease
Date
SignatureofSchoolDSO
Name
andTitle
School
Address
Date
_
Updated10/9/2019
Michigan Technological University is an Equal Opportunity Educational Institution/Equal Opportunity Employer, which includes providing equal
opportunity for protected veterans and individuals with disability.
Note to DSO: Please only transfer the student's
record if it is still in active status. If it has been
completed or terminated, please make a note in
"Other" above that it cannot be transferred and why.
Last
Name
Email
SEVISID#
Michigan Tech ID (M#)
Transfer
Year
Clear Form
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