Print Form
Office of the University Registrar and International Services
65 Bergen Street, Room GA 72, Newark, NJ 07101-1709 * Phone: 973-972-6138 Fax: 973-972-8260
SEVIS RECORD RELEASE REQUEST
This form is to be completed by F-1 students and J-1 Exchange Visitors wishing to transfer out of the University of Medicine and
Dentistry of New Jersey (UMDNJ). Once completed, you must submit this form to International Services together with a copy of the
acceptance letter or offer of employment from a new institution of higher learning. The completed form will then be reviewed by a
Responsible Officer (RO) or Alternate Responsible Officer (ARO) at UMDNJ and the transfer out process of your SEVIS record will be
initiated.
- F-1 students must request a SEVIS release date within 60 days of completion of their program or of the end date on their Optional
Practical Training.
- J-1 Exchange Visitors must request a SEVIS release date of no later than the program end date indicated on the form DS-2019.
Please note that students and scholars wishing to cancel a request for transfer of their SEVIS record must contact International
Services prior to the requested release date. Once your SEVIS release date has arrived. UMDNJ will no longer have any access to your
record and we cannot cancel your request. All changes and modifications will then have to be performed by your new institution.
This section to be completed by the student or exchange visitor only
By completing this form, I am officially requesting the release of my SEVIS record to the institution named below. I understand that
once the SEVIS release date arrives, International Services will no longer have access to my record and all changes and modifications
will have to be performed by my new school/employer. Please type or print clearly.
Current nonimmigrant status:
F-1
J-1
Family name
SEVIS ID#
N
UMDNJ ID # A
First name
Expected date of completion at UMDNJ
Middle name
Requested SEVIS transfer date
Name of new institution you will attend/join
Address of institution
New institution's SEVIS code/program number:
#P
Signature
Date
DO NOT WRITE BELOW THIS LINE
DSO/RO/ARO's name:
DSO/RO/ARO's Signature:
SEVIS release date:
Date transfer request was completed:
Please return this form with a copy of your acceptance letter or offer of employment to the address
shown above.
11/1/2007