August 02, 2006 - Salisbury University
38862000Center for International Education1101 Camden AvenueSalisbury, MD 21801-6860Phone: 410-677-5027Email : sucie@salisbury.edusalisbury.edu/intled/00Center for International Education1101 Camden AvenueSalisbury, MD 21801-6860Phone: 410-677-5027Email : sucie@salisbury.edusalisbury.edu/intled/TRANSFER IN CLEARANCE FORM FOR INTERNATIONAL STUDENTSPart I – to be completed by the studentName: _______________________________ _________________________ _____________________Last (family) First (given) MiddlePresent U.S. school: _________________________________________________________________Present U.S. address:__________________________________________________________________________________________________________________________________Semester and year when you wish to start at Salisbury University:Spring ______ Fall ______ Year YearI authorize the International Student Advisor at my current institution to provide Salisbury University with the information requested in Part II.Student’s signature:___________________________________________ Date: _______________ month/day/yearPart II – to be completed by current school International Student Advisor(1)Current immigration status:_____________________________________________(2)Admission number:_____________________________________________(3)SEVIS number:_____________________________________________(4)SEVIS release date:_____________________________________________(5)Date last attended/completed program at your institution:_________________________(6)Previous CPT/OPT/Economic Hardship authorization (please list all authorization dates):______________________________________________________________________________________________________________________________________________________________________________________________________________________________(7)To the best of your knowledge, has the student maintained his/her immigration status? Yes: _________No: _________ If no, please explain:______________________________________________________________________________________________________________________________________________________________________________________________________________________________DSO printed name: ____________________________________________________________________ DSO signature:__________________________________________ Date: _______________________DSO e-mail address: ___________________________________________________________________DSO mailing address and phone number: ________________________________________________________________________________________________________________________________________International Student Advisor: please fax this form to 410.677.5027 or email to sucie@salisbury.edu. ................
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