Form I-20 - Extension Request - 2016 (Page 3 of 3) in pdf

I-20 Extension Request Form

Academic Advising Information

To Be Completed By Blinn College Advisor

Blinn Student ID Number: B00_____________________________ Date: ________________________

Student Name: _______________________________________________________________________

First Name

Last Name

The student above is requesting an extension of their I-20 in order to complete his/her academic program. Please select

one of the options below to indicate whether or not you recommend the extension. Also, please note the amount of

time you expect the student needs to finish his/her program. For immigration purposes, the student is only eligible to

receive a maximum extension of 2 semesters at a time.

Please indicate the most appropriate reason that applies to this request:

The student has been making academic progress, warranting an extension.

Delay caused by change in major field of study.

Delay due to student required to take developmental classes (must be making notable progress after one year).

Studies interrupted by documented medical condition.

Other compelling academic reason (please explain on a separate page).

The student has not been making academic progress. A program extension is not recommended.

Semester and year student first enrolled in Blinn College credit courses: ___________________________________

Courses student needs to complete for degree program:

(Please attach a separate page if additional space is needed. Alternatively, you can attach a Blinn College Degreeworks

Worksheet.)

__________________________________________________________________________________________________

How many semesters does the student need to complete his/her program:

(Student must be in enrolled in 12 credit hours each semester unless it is their final semester at Blinn.)

___One

___Two

Other (please specify)_____________________

_________________________________________

_____________________________

Advisor/Counselor Signature

Date

This Form Must Be Turned In By The Advisor

Revision 3-7-16 RL

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Form I-20 - Extension Request - 2016 Page 3