American Language Center 01/2009
Transfer Authorization (F-1 Students)
Transfer Authorization form must be completed by the student and authorized individual at the institution which
student is attending or recently attended. It must be returned to school office before new I-20 form can be issued.
Section A
To be completed and signed by the student
Student Name: ________________________________________________________________________________
Last First Middle
Date of Birth: _____/_____/_____ Student ID # (If any) ______________________
I certify that to the best of my knowledge and belief the above information is true and correct.
________________________________________ _____________________
Student Signature Date
Section B
To be completed by International Advisor/PDSO/DSO at last institution attended
American Language Center’s SEVIS school code is PHI214F02108000
Dates of Attendance: __________________ to _________________ I-94 number ___________________________
1. Is student currently in legal status? Yes No
2. Is student eligible to transfer? Yes No
SEVIS ID # ________________________________ SEVIS Release date: _________________________________
Name of school: _______________________________________________________________________________
Address: _____________________________________________________________________________________
Phone Number: _________________________ Email: _________________________________________________
I certify that to the best of my knowledge and belief the above information is true and correct.
________________________________________ _____________________
PDSO/DSO Signature Date
_____________________________________________
Name and Title of PDSO/DSO
www.americanlc.org
Phone: (215) 791-7700
Fax: (215) 947-1003
2910 Franks Rd, Suite 1 Huntingdon Valley, PA 19006