International Studies

International Student Advisor Report

( Current F-1 Students Only )

This report must be completed by the International Student Advisor at your current institution and received at Missouri Southern State College previous to the completion of the admissions process.

International Student Advisor: Please mail or fax this form directly to the address below. Copies of this form hand-carried by the student will not be accepted.

________________________________________________

Surname                                 First Name                            Middle Name

Country of citizenship

Country of birth _

Date of birth _

Visa Classification

Expiration date of I-94 ___

Dates the student attended your institution:

From _To _

8CRF 214.2 (f)(8) An F-1 student who is maintaining status may transfer to another service-approved school by following the notification procedure prescribed in paragraph (f)(8)(ii) of this section. An F-1 student who was not pursuing a full course of study at the school he or she was last authorized to attend is ineligible for school-transfer and must apply for reinstatement under the provisions of paragraph (f)(16) of this section.

The above named student is eligible for transfer in accordance with 8CRF 412.2(f)(8) Yes No

Periods of authorized practical training (please list beginning and ending dates):

Full time curricular __

Part time optional

Full time optional _

Is the student currently authorized to work under the provisions of Severe Economic Hardship?

Yes No

If yes, please list date of authorization _

Do you personally know of any criminal offenses for which this student was convicted?

Yes No If yes, please explain._

____________________

As DSO completing this form, I verify the information above is accurate to the best of my knowledge.

Signature _ Date_

Printed/Typed Name ________________________ Phone _

Title __

E-mail _

Name and address of school _____

                                            _

                                            _______________________

Please mail or fax this form to:

Missouri Southern State College/Admissions

3950 E. Newman Road

Joplin, MO 64801

Fax: 417-659-4429

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