Blinn College F1 Student – SEVIS Transfer‑In Form

Part 1: To be filled out by the student to authorize the transfer of their SEVIS record:
PLEASE TYPE OR PRINT LEGIBLY

1. Full Name (as in passport): _____________________________________________________________________________________________
Last (Family or Surname)    First    Middle

2. Date of Birth: ____________________________________
Month / Day / Year

3. Current U.S. Mailing Address: _____________________________________________________________________________________________
Street and Number / PO Box / Apt #

_____________________________________________________________________________________________
City    State    Zip Code

4. Phone number where you can be reached before enrolling at Blinn College: ____________________________________

5. Email where you can be reached before enrolling at Blinn College: ________________________________________________________________________

6. Please list all F‑2 dependents on a separate sheet of paper and include with this transfer form.

I certify that all the above information is correct and true.

______________________________________________    _________________________________
Signature of Applicant    Date (Month / Day / Year)

Part 2: To be filled out by the International Student Advisor:

SEVIS ID No. ______________________________________________    SEVIS Release Date: ____________________________________

Program Completion Date on Document ____________________________________

Please check and complete all that apply:

______ The student is in good standing and is/has been pursuing a full course of study (or has already been reinstated to status by USCIS).

______ The student is out of status and their SEVIS record has been terminated (do not transfer terminated record, please contact Blinn to discuss student status).

______ The student is not in academic or disciplinary good standing with current institution

______ Other: _____________________________________________________________________________________________

Please indicate the dates of any practical training (curricular, optional, academic) in which the student has participated:
Curricular __________________________    Optional __________________________

_____________________________________________________________________________________________

Printed Name of Designated School Official

______________________________________________

Signature

______________________________________________

Name of Institution    Date

______________________________________________

Address    Telephone Number

______________________________________________

Email address

Please choose the appropriate school code in SEVIS and send this form to the corresponding campus:

Blinn College – Bryan Campus – SNA214F02310000
Blinn College – RELLIS Campus – SNA214F02310001
Blinn College – Brenham Campus – HOU214F00216000

Email to: international@blinn.edu
Phone: 979‑209‑7699

Mailing Address:
Blinn College
International Student Admissions
P.O. Box 6030
Bryan, TX 77805