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TO: The
International Student transferring from a U.S. institution: The Department of Homeland Security requires that this office have the following information in your file in order to process your application. Please complete Section 1 and have your current or most recent Foreign Student Advisor (Designated School Official) complete Section 2. THIS FORM MUST
BE COMPLETED BY YOU (SECTION 1) AND BY YOUR ADVISOR (SECTION 2) TO: The Foreign Student Advisor (DSO) : NOTE: SEVIS NAME: SCHOOL CODE : ATL214F01610000
Alpha Hall East #221
E-mail: usaesl@jaguar1.usouthal.edu Section 1: To be completed by the student: Print
Your
Name:_________________________________________________________________________________
Name of Country of Citizenship:__________________ Country of Birth:__________________________________ Date Of Birth:___________________ Social Security Number:__________________________(Voluntary) I
request and authorize my present (or most recent) Foreign Student Advisor
(DSO) to provide the following information as part of my application for
admission to the University of South Alabama English Language Center. __________________________________________________ (Signature of Student) Print Present Address:
___________________________________________________________________ THIS FORM MUST BE COMPLETED AND RETURNED TO ELC BY YOUR ADVISOR BEFORE ANY ACTION CAN BE TAKEN ON YOUR FILE Section 2: To be
completed by the Foreign Student Advisor: NOTE: SEVIS NAME: Name of Student:
_______________________________________________________________________ Visa type: _______ I
-20 expiration date:______________ INS Admission Number: _________________ SEVIS
ID #____________________________SEVIS
Release Date: ______________________________ Passport Information: Please circle the
correct answer and explain all NO response: 1. Is the student attending
the school last authorized to attend by I.N.S.?
______________________________________________________________________________________ I certify the preceding is to the best of my
knowledge true and correct. ______________________________________________________________________________________ E-mail: ___________________
Fax:_____________________ Phone: (____
)__________________ Institution's Address:
_____________________________________ _____________________________________ |
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