F-1/J-1 Transfer Request Form

* Indicates a required field

A. Student/Scholar Information Section

F-1 or J-1 international students/scholars who are transferring to the University of Richmond (SEVIS School Code WAS214F10016000/Program Number P-1-0320 need to complete this form in addition to the I-20/DS-2019 Authorization Form.

Please sign the release of information statement below and give this form to the international student/scholar advisor at the school or program you now attend or have most recently attended.

* I grant permission for the information requested below to be released to University of Richmond.
Yes No

* Given (first) name:
Middle initial:
* Family (last) name:

* Signature: *Date:

For F-1 visa holders only: Academic Term of last attendance at educational institution (ex: Fall 2005):
I-20/DS-2019 Reqeusted Transfer Date to Richmond from current institution/program:

Mailing Address - where you would like your new I-20/DS-2019 sent:

Street 1:
Street 2:
Zip/Postal Code:
Telephone number:

B. Designated School Official/Responsible Officer Section

The above-named international student/scholar has qualified academically for admission or program participation to the University of Richmond. In compliance with immigration regulations, we request confirmation of his/her status in your institution/program before approving transfer to this school.

Please complete the following information:

F-1 student
J-1 exchange visitor

End Date on I-20/DS-2019 (MM/DD/YYYY):

Name of Institution/Program Sponsor:

SEVIS School Code/Program Number:

The student/scholar is in good standing and is pursuing a full course of study or fulfilling their program objectives (or has already been reinstated to status by USCIS/U.S. Department of State).

The student/scholar is out of status and a reinstatement to status was filed on with USCIS Service Center/U.S. Department of State and is pending. (Please email a copy of the filing to konsanit@richmond.edu.)

The student/scholar is out of status, and we will advise them to apply for reinstatement upon receipt of a new I-20/DS-2019 from University of Richmond.

Other - Please explain:

Please indicate the star and end dates of any practical/academic training:

Name and Title of Designated School Official/Responsible Officer completing this Form:

* Name
* Title

Name and Address of Institution

* Name
* Street 1
Street 2
* City
* Zip/postal code
* Country
* Telephone number
* Fax number
* Email Address

* Signature Signature Date: