F-1 Student Sevis Record Transfer (Advisor)

Student First/Given Name as it appears in SEVIS

Student Last/Family Name as it appears in SEVIS

Student Birthdate

Student SEVIS ID#

What date do you intend to release this student's record in SEVIS to State University of New York at Plattsburgh S.U.N.Y. Plattsburgh (BUF214F00386000)?

To the best of your knowledge, is the student currently in status?

Yes

No

If not, please explain:

When was the student last considered full-time at your institution?

If the student has been granted practical training, please indicate the type and dates:

Has the student met his/her financial obligations to your institution?

Yes

No

If not, please explain:

Please upload a supplemental PDF here (if applicable):

I CERTIFY THAT ALL INFORMATION ON THIS FORM IS TRUE TO THE BEST OF MY KNOWLEDGE.

School Name

School Level of Study (hidden)

School SEVIS Code

School City

School State

Signature of school official (please type name):

Title

Advisor's phone number (Country Code - City Code - Number)

Advisor's email address