This document is an application for an F-1 student visa extension. It contains sections for information about the student such as name, SEVIS number, address, and required financial documentation. It also contains a section for the student's academic advisor to provide details on the student's academic program and progress, including the reason an extension is needed and the expected completion date. The advisor must sign off on the application along with their contact information.

1. Application for F-1 Extension of Stay
Section A. (To be completed by student) Date: __________________
Student Name: ___________________________, ___________________________ ________
Last First Middle Initial
SEVIS #: N __ __ __ __ __ __ __ __ __ __ Banner #: V __ __ __ - __ __ - __ __ __
Current Address: _____________________________________________________________________
Number, street apt. City State ZIP Code
Birthdate: ______________ E-mail: _________________@vcu.edu Phone: __________________
Attach appropriate bank statements to prove required funding. (These statements must be either on
official 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/yyyy
Academic adviser name: ____________________________ Phone: __________________________
E-mail address: ______________________________ Department: ___________________________
Academic adviser signature: ________________________________ Date: ____________________
Updated 2010
Global Education Office - Immigration Services
817 W. Franklin Street, P.O. Box 843043, Richmond, VA 23284 Tel: (804) 828-0595 Fax: (804) 828-2552