Fillable Request To Transfer Out To Another University Form printable pdf download

Center For International

Education

865.974.3177

1620 Melrose Avenue

Knoxville, TN 37996-3531

Request to Transfer Out to

Another University

NOTE:



International students who intend to transfer from UT to another university must complete this form before UT will transfer

their SEVIS record to another university. Please be advised that no other school will be able to issue your new I-20 until UT

has released your SEVIS record. Your SEVIS record will not be released until you turn in this form, completed and

signed along with an acceptance/admission letter from the university where you intend to transfer.

Name ____________________________________________________________________________________ UT ID ____________________________________

Family/Last

Given/First

UT e-mail ______________________________________________________________

SEVIS ID# ___________________________________________

Current degree level (please check one):  Bachelor’s

 Master’s

 Doctorate

Please answer ALL of the following question(s):

I have been admitted to attend: Name of School _____________________________________________________________________________

Address _____________________________________________________________________________

City, State, Zip Code _______________________________________________________________

For which semester (check one):

 Fall

 Spring

 Summer

Year _______________

My last term of enrollment at UT will be:  Fall

 Spring

 Summer

Year _______________

Please check the appropriate box:

 I am graduating from UT and will be beginning a new degree program at the new university.

Graduating UT with:  Bachelor’s  Master’s  PhD

Major: ___________________________________________________

 I am leaving UT and will be completing my current program at the new university.

 I am currently on Optional Practical Training. My last day of employment is ______________________________________________

(mm/dd/yyyy)

Do you hold a Graduate Assistantship?  Yes

 No If yes, my assistantship will end on ____________________________

(mm/dd/yyyy)

*Note: Once the transfer effective date has been reached, you are no longer allowed to work at The University of

Tennessee, Knoxville, as you will then no longer be in our SEVIS database.

For CIE Use Only

I give permission to The University of Tennessee, Knoxville to release my

Holds: □ Yes □ No Date Cleared: _________

SEVIS record to the above named school. I certify that the information

provided on this form is true and correct to the best of my knowledge.

Updated in Access: □ Yes □ No

Release Date:

_____________________________

Student Signature _________________________________________________________

SEVIS Release Date Set: □ Yes □ No

Date ________/________/________

Full-Time Enrollment: □ Yes □ No

Notes:

If you have questions, please contact CIE at (865) 974-3177.

___________________________________

Completed by: ___________

Date: __________

I:\Vol06\Center for International Education\Int'l Students and Scholars\Forms and Handouts\For Students\Forms\Transfer Out

Form.doc

Updated: June 3, 2016

Request To Transfer Out To Another University Form

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