University Student Affairs – California

F-1 regulations permit a student to transfer from one Student and Exchange Visitor Information System (SEVIS) approved school to another. There can be no more than a five (5) month gap between schools from the last date you attended, or the last day of your Optional Practical Thinking (OPT), whichever is later. OPT will terminate on the transfer release date and you cannot continue to work past the release date. The deadline to request a transfer is sixty (60) days after your program completion date or OPT end date, whichever is later.

If you have any questions, please do not hesitate to contact Daniell Mendoza at:

Admissions Office
309 E. Second Street
Pomona, CA 91709
Phone: (909)-469-5541
Fax: (909)-469-5570
E-mail: dwitsoe@westernu.edu

Student to complete all sections below.

I acknowledge that:*

I am requesting Western University of Health Sciences (WesternU) to release my SEVIS record to the institution named below.

I acknowledge that:*

I will provide WesternU a copy of my acceptance letter with this form.

Name*

(as on I-20)

First Middle Last

WesternU ID Number*

Must include @ symbol.

SEVIS ID Number*

Begins with letter "N."

WesternU E-mail Address*

Name of New Institution Attending*

Address of New Institution Attending*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Institution SEVIS Code

Date Classes Begin at New Institution*

SEVIS Transfer Release Date Requested*

Date you are requesting to have your SEVIS record transferred out.

How do you plan to provide a copy of your acceptance letter?*

Upload now
Fax to Daniell Mendoza
Mail to Daniell Mendoza

Upload Acceptance Letter*

Only .pdf accepted and you may upload multiple documents if necessary.

Drop files here or

Accepted file types: pdf, Max. file size: 125 MB.

Please fax a copy of your acceptance letter to Daniell Mendoza at (909)-469-5570 as soon as possible.

Please mail a copy of your acceptance letter to Daniell Mendoza as soon as possible at:

Attn: Daniell Mendoza
Admissions Office
309 E. Second St.
Pomona, CA 91709

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F-1 Transfer Out Form