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  • 1. O f f i c e o f G l o b a l E d u c a t i o n I m m i g r a t i o n T r a n s f e r - I n C l e a r a n c e F o r m 817 W. Franklin Street, P.O. Box 843043, Richmond, VA 23284. Fax: (804) 828-1829 Tel: (804) 828-6016 E-mail: vcuia@vcu.eduPlease give this form to the International Student Adviser at your current institution. You are required to submit this formbefore we can finish your immigration transfer. Once it is complete, return it with copies of all of your previous I-20s, frontand back, to our office.SECTION I: To be completed by studentLast Name ______________________________ First __________________________ Date of Birth (m/d/yy)______________ Current US address: Permanent residential address in home country:Street _________________________________________ Street _____________________________________________City ________________________________ State _____ City ______________________ Postal code ______________ZIP _____________ Phone ________________________ State/Province _________________Country ______________ Phone (w/country code) ______________________________ Student Signature ________________________________________________SECTION II: To be completed by International Student Adviser at student’s institutionName of Student ________________________________________________ SEVIS Number N_________________________Visa type _____ F1 _____ J1 _____ otherDates of attendance at your school: From ___________________ to ____________________Transfer out date _________________________Student has maintained his/her legal status _____ Yes _____ NoStudent is eligible to continue at your school _____ Yes _____ NoStudent has been approved for practical training _____ Yes _____ No Dates ________________Date of completion on current I-20 document ____________________Do you recommend transfer? _____ Yes _____ NoAny additional dependants on current I-20 ___________________________________________________________Comments __________________________________________________________________________________________________________________________________________________________________________________________________DSO Name (print) _______________________________________________ Title __________________________________Institution _________________________________________ Address ____________________________________________Signature ___________________________________________ Date _________________ Phone ______________________