J-1 Scholar Transfer-Out Form
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1SYRACUSE UNIVERSITY
L
E
S
C
I
S
J-1 Scholar
ILLIAN AND
MANUEL
LUTZKER
ENTER FOR
NTERNATIONAL
ERVICES
310 Walnut Place | Syracuse, New York 13244-2380
Transfer Out Form
TEL: 315-443-2457 | FAX: 315-443-3091
LESCIS@SYR.EDU
EMAIL:
WEB:
For J-1 Scholar transfer from Syracuse University to another Exchange Visitor Program
US Citizenship and Immigration Services requires that an international student or scholar’s eligibility to transfer to another institution in the United States be
confirmed prior to the issuance of new immigration documents. Section I should be completed by the J-1 Scholar who is transferring out of Syracuse
University; Section II should be completed by the Responsible Officer or Alternate Responsible Officer at the institution to which the J-1 Scholar intends to
transfer. Please note, your SEVIS DS-2019 cannot be released until the last day of service to Syracuse University is complete.
SECTION 1: TO BE COMPLETED BY J-1 SCHOLAR TRANSFERING OUT
Name: ____________________________________________________________________________________________________________________
Family Name
Given Name
Middle Name (optional)
Current Address: ___________________________________________________________________________________________________________
Apt. or House Number
Street
P.O. Box
___________________________________________________________________________________________________________
City
State
Zip Code
Current J-1 Category (Research Scholar, Professor, Short-term Scholar, Specialist) : ____________________________________________________
Current J-1 Subject/Field of Research (i.e. Electrical Engineering, Chemistry, etc.) : _____________________________________________________
Last Date of Service to Syracuse University: ___ __________________________________________
Month/ Day/ Year
Begin Date of Service to new institution:
______________________________________________
Month/ Day/ Year
Syracuse University will transfer the J-1 DS-2019 Record to the new university after the last date of service to SU.
By signing below, you grant permission to SU’s RO/ARO to transfer your SEVIS Record.
J-1 Scholar’s Signature: ______________________________________________________________
Date: _____________________________
SECTION 2: TO BE COMPLETED BY RO/ARO (J-1 SCHOLAR ADVISOR) AT NEW INSTITUTION
University Name: _________________________________________________________________________________________________________
EV Program Number: _____________________________________ Intended start date of scholar’s service: ________________________________
Intended J-1 Category: ____________________________________ Intended Subject/Field: ____________________________________________
RO/ARO Name: ___________________________________________________ Title: __________________________________________________
Email: ___________________________________________________________ Phone: _________________________________________________
Office Address: __________________________________________________________________________________________________________
Street
P.O. Box
__________________________________________________________________________________________________________
City
State
Zip Code
RO/ARO Signature: ______________________________________________________
Date: __________________________________________
Please return this document by mail or fax to:
Syracuse University
(315) 443-2457 phone
Slutzker Center for International Services
(315) 443-3091 fax
310 Walnut Place
lescis@syr.edu
Syracuse, NY 13244-2380
EV Program Number: P-1-00245
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