Extension request form

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Extension request form

  1. 1. Application for F-1 Extension of StaySection A. (To be completed by student) Date: __________________Student Name: ___________________________, ___________________________ ________ Last First Middle InitialSEVIS #: N __ __ __ __ __ __ __ __ __ __ Banner #: V __ __ __ - __ __ - __ __ __Current Address: _____________________________________________________________________ Number, street apt. City State ZIP CodeBirthdate: ______________ E-mail: _________________@vcu.edu Phone: __________________Attach appropriate bank statements to prove required funding. (These statements must be either onofficial bank letterhead paper or signed by a bank official.)Section B. (To be completed by academic adviser)Academic Program: ___________________________________ Degree level: __________________1. Reason that extension is required: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________2. Briefly describe student’s academic progress: ____________________________________________________________________________________________________________________________________________________________________________________________________________________3. Number of credits still required to graduate: __________________4. Expected completion date for all requirements of academic program: __________________ mm/dd/yyyyAcademic adviser name: ____________________________ Phone: __________________________E-mail address: ______________________________ Department: ___________________________Academic adviser signature: ________________________________ Date: ____________________Updated 2010Global Education Office - Immigration Services817 W. Franklin Street, P.O. Box 843043, Richmond, VA 23284 Tel: (804) 828-0595 Fax: (804) 828-2552

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