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F-1 STUDENT SEVIS RECORD TRANSFER

This form must be completed by a Designated School Official (DSO).

ATTENTION: Please do not transfer the student’s SEVIS record to our office without first confirming the student's official acceptance with the Western Covenant University admissions office via email info@wcuniversity.edu or phone (213) 293-1771. Once confirmed, please release the student's I-20 to our SEVIS School Code: LOS214F54333000

Thank you!

STEP 1. TRANSFERING STUDENT INFORMATION

First Name^*

Last Name^*

Email^*

Student’s Current 1-20 Expiration Date:

Is the student within the grace period?

Yes No

The student's end date at your institution

Student's Transfer Status

The student is in status and is eligible to transfer according to 8 CFR214.2(f)(8)(i) The student is out of status.

SEVIS Termination Date:

Reinstatement filed on:

Authorized Employment (if any) CPT Dates:

Authorized Employment (if any) OPT Dates:

Additional Comments

STEP 2. YOUR INSTITUTION'S INFORMATION

Name of Your Institution ^*

Address^*

Phone Number^*

Institution's SEVIS # ^*

DSO's Name ^*

DSO's Email^*

SEVIS Record Release Date

Agreement ^*

By typing my name below I am signing this agreement electronically. I agree that my electronic signature is the legal equivalent of your manual signature on this agreement.

Signature^*

Please type your full name

Signature date^*

F-1 STUDENT SEVIS RECORD TRANSFER

This form must be completed by a Designated School Official (DSO).

STEP 1. TRANSFERING STUDENT INFORMATION

STEP 2. YOUR INSTITUTION'S INFORMATION

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