International St
udent Transfer Form
Admissions and Records - Arapahoe Community College - 5900 S. Santa Fe Drive - Littleton, CO 80160-9002
Email: admissions@arapahoe.edu
S
EVIS Code: DEN214F00239000
Part I. (To be completed by the international student.)
_____________________________ _________________________ ______________
Last name First name Middle name
_____________________________ _______________________ ________________
SEVIS # Country of Citizenship I 94 #
_____________________________ _________________________ ______________
Social security number Phone number Birth date
I hereby authorize the International Student Advisor (or equivalent university official) to provide the
information below as part of my application to ACC.
_________________________________________ ______________
Signature Date
Part II. (To be completed by International Student Advisor.)
Please check and complete all that apply:
This student
is in good standing and is/was enrolled in a full course of study from ____________
until ___________.
This student
is out of status and a reinstatement to student status was filed on (date) ___________ with
USCIS in (location) ________________ and is pending.
This student
is out of status and must file for reinstatement. Include explanation.
This student
has previously been granted practical training; please specify type(s) and dates.
_________________________________________________________________________________
Other (or comments):______________________________________________________________________
__________________
________________________ ___________________________________________
DSO Signature DSO Name
__________________
________________________ ___________________________________________
DSO Title School Name
__________________
________________________ _____________________ _____________________
School Address City/State/Zip Date
__________________
________________________ _____________________ _____________________
DSO Email Address Phone # Fax #
TRANSFER OUT DATE ____________________
Revised 09.22.2016
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