Issi Form 133 Certification Of Program Completion For International Students Page 2
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2Part II: Verification: To be completed by the student’s academic advisor or program director
A. Verification:
This student seeks change of degree level from PhD to Master’s program in a Grad school, or Certificate to Master’s
program in CPS.
This student has maintained full-time academic status during the regular academic terms and has been making
satisfactory progress toward the successful completion of his/her program.
This student could not maintain full-time status during the regular academic terms for the following reason(s):
____________________________________________________________________________________
____________________________________________________________________________________
B. Date of Program Completion:
Semester Based Programs
Quarter Based Programs
□
□
Fall (December 20)
Fall (December 19)
□
□
Spring (May 8)
Winter (April 3)
Program Completion Year:
□
□
Summer I (July 2)
Spring (July 3)
____________
□
□
Summer II & Full Summer (August 29)
Summer (August 30)
□
Other: __________________ (i.e. Law school, thesis/dissertation)
IMPORTANT
According to immigration regulations, on-campus employment and Graduate Assistantship must end by the end of the
term you are enrolled. The current I-9 will be adjusted accordingly.
Part III: Signatures: To be completed by the Academic Department and Dean/SEVIS contact
Academic Advisor or Program Director (required):
To the best of my knowledge, the information pertaining to this student is accurate and complete.
Print Name: ______________________________________________ Title: _________________________________
Signature: __________________________________________ Phone: _______________ Date: _________________
Dean or SEVIS contact: (required for Graduate students and all CPS students - if Academic Advisor is different from SEVIS
contact)
To the best of my knowledge, the information pertaining to this student is accurate and complete.
Print Name: ________________________________________College/Graduate School: ___________________________
Signature:__________________________________________ Phone: _________________ Date: _________________
ISSI 133 MFS IK 022416-[Q] W
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