University Of Nebraska At Omaha School Transfer Form
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1International Admissions
University of Nebraska at Omaha
SCHOOL TRANSFER FORM
6001 Dodge Street
Omaha, Nebraska 68182-0080
Phone Number: 402.554.2293
Complete this form only if you are requesting to transfer to the University of Nebraska at Omaha from another institution in the U.S.
Please complete Part I of this form and submit it to the International Student Advisor at the U.S. school in which you are currently enrolled or the
U.S. school you most recently attended. The International Student Advisor should complete Part II of the form and return it directly to the
address above. THE FORM SHOULD NOT BE RETURNED TO THE STUDENT.
PART I
(to be completed by applicant)
Name of student: ____________________________________________________________________________________________________
Last name
First name
Middle name
Country of Citizenship: ______________________________________
Type of visa: _______________________________________
I-94 Admission Number: _____________________________________
SEVIS Number: ____________________________________
United States Address: _______________________________________________________________________________________________
Street
City
State
Postal code
I, ___________________________________________, authorize release of all information on this form.
(Student’s signature)
PART II
(to be completed by the International Student Advisor or other Designated School Official)
Please return this form directly to International Admissions at the University of Nebraska at Omaha,
6001 Dodge Street, Omaha, NE 68182-0080 or fax it to 402.554.2949.
The Above-Named Student:
_____ is taking a full course of study at this school.
_____ is taking less than a full course of study at this school.
_____ terminated attendance on (date) _____________ and WAS/WAS NOT taking a full course of study.
_____ is in FULL F-1 STATUS
_____ is OUT OF STATUS
□
□
Does this student have a SEVIS I-20 from your school?
YES
NO
If “YES,” what is the SEVIS release date for this student? _______________________________
□
□
Is the student in good academic standing and able to re-enroll the next semester?
YES
NO
If “NO,” please explain: _______________________________________________________________________________________________
__________________________________________________________________________________________________________________
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□
Has the student engaged in Practical Training?
CPT _______________ (Dates)
OPT ___________________ (dates)
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Has the student had financial / health / disciplinary / adjustment difficulties?
YES
NO
**If you wish to make any additional COMMENTS, please use the reverse side of this form. We appreciate your assistance and assure you that
this information will be held in strict confidence.
_______________________________________
_______________________________________________
Print name of School Official
Name of Institution
________________________________________
_______________________________________________
Signature of School Official
Address of Institution
Street
________________________________________
_______________________________________________
Official Title of School Official
City
State
Postal Code
________________________________________
_______________________________________________
Phone Number
E-mail Address
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