Fillable edmonds community college Transfer Eligibility Form

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edmonds community college Transfer Eligibility Form

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Transfer Eligibility Form Updated on: 11/22/2013
International Student Services (ISS)
Edmonds Community College
20000 68
th
Ave. W. Lynnwood, WA 98036
Tel: (425) 640-1518, Fax: (425) 774-0455
E-mail: issadmissions@edcc.edu
Web: http://www.edcc.edu/international/
This form is NOT an acceptance letter and does not ask for the release of your SEVIS record to EdCC. Your SEVIS
record will only be released to EdCC after you are accepted by us.
Student to Complete
Last/Family Name:_________________________________ First & Middle Name:_______________________________
Email: _____________________________________ Tel: ________________________ DOB:____ /_____/_____
Month Day Year
Do you plan to travel outside the U.S. before attending EdCC? Yes No
(If yes, you may need an EdCC I-20 to re-enter the U.S.)
Travel Date: From:______/____/_____ To:_____/____/______
Month Day Year Month Day Year
Current School ID #: _____________________ Signature:______________________ Date:_____________
I authorize my current U.S. school to release information about my school transfer.
SEVIS ID #:N______________________ Attendance Date: From: _____ /_____ /____ To: _____ _/______ _/_____
Month Day Year Month Day Year
Is the student currently enrolled? Yes No
Has the student fulfilled financial obligation to your school? Yes No
Is the student in status to your knowledge? Yes No
Comments:
______________________________________________________________________________________________
Periods of authorized employment: OPT: From______/______/____ To:_______ /_______ /_____
Month Day Year Month Day Year
Most recent periods of authorized reduced course load and /or annual school vacation:__________________________
________________________________________________________________________________________________
SEVIS record will be released upon receiving an acceptance letter from EdCC.
Estimated SEVIS release date upon acceptance: ______/_______/______ EdCC SEVIS Code: SEA214F00298000
Month Day Year
Name (please print):_____________________________________ Signature and Date: _______________________
E-mail:_______________________________________________ Phone Number: __________________________
School Name and Address:_________________________________________________________________________
Section A
:To be completed by STUDENT (Please Print or Type)
Section B
:
To be completed by ADVISOR
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edmonds community college Transfer Eligibility Form

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Completed 21 January 2020

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