F-1 Student Transfer In Form
Student Information
To be completed by student.
Name
*
First
Middle
Last
Current U.S. Address
*
Street Address
Address Line 2
City
Select One
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
City of Birth
*
WesternU E-mail Address
*
Telephone Number
*
WesternU ID Number
*
Must include @ symbol.
SEVIS Number
*
Begins with letter "N."
Program
*
Select One
DO
DMD
DPM
OD
DVM
Nursing: ADN-MSN
Nursing: BSN-MSN
Nursing: DNP
Nursing: FNP
Nursing: MSN-FNP
Nursing: MSN-E
DPT-Post Professional
DPT
MSHS
MSPA
PharmD
PharmD International
MSPS
MSBS
MSMS
Program Start Date
*
MM slash DD slash YYYY
Are you attending a summer Prep program?
*
Yes
No
Proof of Funding
Please submit your affidavit of support for one academic year (minus the loan fees) along with this form. Student Budgets can be found on our website at
http://www.westernu.edu/financial/financial-budgets/
. Financial documents cannot be older than 6 months prior to the start of classes. Electronic copies are acceptable.
All funds must be in U.S. dollars.
Personal/Family Funds
Government Sponsor
WesternU TA, RA, etc.
Please include a copy of your offer letter.
Upload Proof of Financial Support
Max. file size: 125 MB.
Other Funds (please specify)
Other Amount
Are you currently on Optional Practical Training (OPT)?
*
Yes
No
If yes, what is the completion date for your OPT?
*
MM slash DD slash YYYY
I acknowledge that:
*
I authorize my current institution to provide WesternU with my current school information.
Please provide us with contact information for the DSO at your current school. They will receive a copy of this entry and will be asked to provide us with your current school information.
DSO E-mail Address
*
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