TRANSFER FORM

Please return this form to:

ELTI

267 Health & Human Services Bldg.

UNC-Charlotte

Charlotte, NC 28223

Tel. 704-687-7742, Fax 704-687-3168

SECTION I: To be completed by the applicant

NAME OF APPLICANT: ____________________________________________________________________________      

                                                     (LAST/FAMILY)                                  (FIRST/GIVEN)                     (OTHER)

US ADDRESS:     ____________________________   PERMANENT                ________________________________

                              ____________________________   (NON U.S.) ADDRESS: ________________________________

                              ____________________________                                            ________________________________

COUNTRY OF                                                                  COUNTRY OF

CITIZENSHIP: ______________________________     PERMANENT RESIDENCE: ___________________________

SEMESTER OF                                                                       CURRENT ACADEMIC

INTENDED ENROLLMENT: _____________________     INSTITUTION (IF ANY): ___________________________

SECTION II: To be completed by the designated school official for F-1 students

Is the student currently attending the school he/she was last authorized to attend? _______________________________      If no, please explain:  _________________________________________________________________

To the best of your knowledge, is this student currently in lawful F-1 status? ___________________________________

        If no, please explain: ____________________________________________________________________________

 I-94 Admission Departure Number: _____________________________    Date first granted F-1 status______________

Applicant’s SEVIS ID # : ____________________________________  Transfer release date______________________

Program Level the student has most recently been authorized to pursue: _______________________________________

Please provide any other information about this student’s immigration status, financial history, or situation    

     which might be helpful as we assess his/her documentation: ______________________________________________

THE STUDENT’S SEVIS RECORD SHOULD BE TRANSFERRED TO THE ‘UNIVERSITY OF NORTH CAROLINA AT CHARLOTTE’ (SCHOOL CODE ATL214F10291000).

_________________________________________________________________________________________________

I certify that the preceding is correct.

__________________________________      ____________________________________________        ____________

Signature of School Official                              Name and Title of Official                                                      Date      

_________________________________________________________________________

Name and Address of Institution

Phone: ____________________    Fax: ________________________ E-mail:_________________________________