ENGLISH LANGUAGE INSTITUTE
SEVIS TRANSFER REQUEST FORM
To Be Completed by the Student:
Student Name: ________________________, ________________________, _____________________
Last Name
First Name
Middle Name
Current School ID#:__________________________________
I intend to transfer to Pace University starting _____/ _____/ _____I hereby authorize release of the
information requested below.
Month Day
Year
Campus
New York City Campus
Pleasantville (Westchester) Campus
_________________________________/__________
Student Signature
/ Date
Pace I.D. #: ________-______ -________
To Be Completed by the Designated School Official (DSO) of Current School
The student named above has indicated an intention to transfer to the English Language
Institute at Pace University NYC214F00449009.
Please provide the information requested so that the student’s eligibility for an immigration
transfer may be determined.
SEVIS ID #: _____________________ Release Date: ____________________________________
Please indicate the dates of attendance at your school (Semester, Year):
From _____/ _____/ _____
Month
Day
Year
To _____/ _____/ _____
Month
Day
Year
Was she/he considered to be pursuing a full course of study at your institution?  Yes
Is/Was this student authorized by USCIS to attend your institution?
 Yes
 No
 No

Student did not report to this school

Should the student file for reinstatement?  Yes  No (If no, Please explain).
________________________________________________________________________

Student reported to the school but did not attend. (Please explain).
________________________________________________________________________

Student completed the course of study at this school on: ____________________________

Student did not complete the course of study. He/she attended classes until: ___/ ___/___

In your opinion, is the student eligible for school transfer?  Yes  No
1
Comments:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Please release the student to
NYC214F00449009 - PACE UNIVERSITY – ENGLISH LANGUAGE INSTITUTE
DSO Name:___________________________________
DSO Signature: ____________________________
Title: _________________________________________
Institution: ________________________________
Address: ____________________________________________________ Date: _________________________
Tel: ______________________
Fax: ____________________ Email:______________________________
Please return this form by fax or e-mail with a copy of the student’s I-20 form(s)
to the campus the student will attend:
Pace University
English Language Institute
1 Pace Plaza
New York, NY 10038
Phone: (212) 346-1562
Fax: (212) 346-1301
[email protected]
2
Pace University
English Language Institute
861 Bedford Road
Pleasantville, NY 10570
Phone: (914) 773-3820
Fax: (914) 773-3822
[email protected]