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
Section 1: To be completed by the student:
Country of Citizenship:__________________ Country of Birth:__________________________________
Date Of Birth:___________________ Social Security Number:__________________________(Voluntary)
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: ______________________________
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: _____________________________________