Travel Permission Form - Pepperdine University
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1OFFICE OF INTERNATIONAL STUDENT SERVICES
TRAVEL PERMISSION
Allow at least 48 hours for processing.
CWID ___ ___ ___ ___ ___ ___ ___ ___ ___
SEAVER
GSBM
GSEP
SPP
LAW
Last Name ______________________ First Name ______________________ Cell ____________________________
_________________________________________________________________________________________________
U.S. Address
Street
Apt
City
State
Zip Code
Major___________________________ Minor ___________________
Departure date:
_____/ _____/ _____
Return date:
_____/ _____/ _____
Month
Day
Year
Month
Day
Year
When was the most recent I-20 issued? _____/_____/_____ When was page 3 of the I-20 signed? _____/_____/ _____
Month
Day
Year
Month
Day
Year
List all countries that you will be visiting: ________________________________________________________________
Are you departing for a study-abroad program? Yes
No
Where? _____________ When?
_____/ _____/ _____
Month
Day
Year
Passport expiration date:
_____/ _____/ _____
Visa expiration date:
_____/ _____/ _____
Month
Day
Year
Month
Day
Year
Expected program end date:
_____/ _____/_____
Month
Day
Year
Your plan after graduation:
OPT
Return home
Transfer
Other ________________________
Write your initials after you have read and agreed to comply with each of the following points:
_____
Immediately after returning from my trip, I will print a copy of my new electronic Form I-94.
I will save an electronic copy of all of my Form I-20’s and other government documents.
_____
_____
I will obtain the necessary visa for each country of my destination, including transit visas for stopovers.
_____
I will apply for a new F-1 visa if it will expire before my date of reentry to the U.S.
To apply for OPT, I will read the information in the “OPT Manual” in the OISS website in its entirety 5-6 months before
_____
completion of study.
If I will be absent from the U.S. for 5 months or more, I will request a new Form I-20 issued for “initial attendance”, pay a
_____
new SEVIS I-901 fee, and re-start a new status under a new SEVIS ID number, and apply for a new visa.
_____
If I apply for U.S. permanent residence, I will consult my attorney regarding my ability to return in F-1 status.
_____
I will promptly notify the OISS of any changes to the information I provided on this form
Please choose one:
I will pick up my I-20, or I grant permission to ______________________________ to pick it up on my behalf.
For express delivery, please submit a request UPS shipping label through
(next-day).
I would like my I-20 sent to my Pepperdine inter-campus mail in care of __________________________________
I have answered all of the questions in this form truthfully. I understand it is my responsibility to maintain my lawful
F-1 status and prepare all of my immigration documents in order to return to the U.S. in F-1 status.
Date: _____/ _____/ _____
Signature ____________________________________
_____/ _____/ _____
Month
Day
Year
Month
For office use only:
___ Signed on _______ line.
Received by:_____________________
Date: __________________________
___ New I-20 issued for:___________________________________________
by _____________________ Date:___________________________
24255 Pacific Coast Highway, Malibu, California 90263-4246, USA ▪ Phone: +1 310-506-4246 ▪ E-mail: oiss@pepperdine.edu
Revised on 7/1/2015
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