Request For A Status Letter Form
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1REQUEST FOR A STATUS LETTER
To avoid delays in processing, please print clearly and complete all information below and on the back.
5 – 7
Please allow ISSS
working days to process your letter. Thank you.
Name: _____________________________ , _____________________________
Visa Status: ________________
(Last/Family Name)
(First Name)
(F-1, J-1 Student/Intern, J-1 Scholar)
Student ID # : ____________________________
SEVIS ID # : N00________________________________
(9 digits # starting with 000-/ 001- )
Date of Birth : ________________
Female _____ Male _____
(mm/dd/yyyy)
: Bachelor’s ____ Master’s ____ Doctorate ____ Non-Degree ____ Other
Level of Study
__________
(please specify)
Field of Study
Current End Date on I-20 (or DS-2019):
: _______________________________
______________
(mm/yyyy)
Number of credits you are registered for
Do you have an assistantship
this semester_________
? __________
Where: _______________________________
(Note: Your request cannot be processed unless you are enrolled full time or
have a Reduced Course Load Authorization form on file in ISSS.)
________
Are you currently on OPT or CPT?
Off-campus Employment
)
(Optional/Curricular Practical Training; F-1 Off-campus Employment
OPT Start Date____________
OPT End Date____________
Phone: _______________________ Preferred Email: ____________________________________
Contact Information
(Please print)
The purpose of your request:
____ Applying for a Social Security Number
(
Please attach a copy of the employment letter along with this request form)
What kind of job? On campus_____
Assistantship_____
OPT_____
CPT _____
When will your job/OPT/CPT start?______________________
____ Visa Renewal in
home country or
another country.
_____
_____
_______________________
_______________
Name of the country:
Dates of travel:
Renewal for _____ self, or _____ dependent(s) – P
’
lease
dependent(s)
complete
info below
Dependent Information (include Name, Relationship, Date of Birth):
____________________________________________________________________________________
____ Other, please explain: __________________________________________________________________
You may request a General Status Letter (showing that you are enrolled full time) if you have a Reduced Course
Load Form on file with our office. If you are a full time student, you may request an enrollment verification form
from the Registrar’s Office.
Today’s Date:_________________
Signature of Student: ________________________________________
ISSS Office Use
Due Date:
Logged Date:
Completed:
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