Application for F-1 Extension of Stay

Section A. (To be completed by student) Date: __________________

Student Name: ___________________________, ___________________________ ________ Last First Middle Initial

SEVIS #: N __ __ __ __ __ __ __ __ __ __ Banner #: V __ __ __ - __ __ - __ __ __

Current Address: _____________________________________________________________________ Number, street apt. City State ZIP Code

Birthdate: ______________ E-mail: _________________@vcu.edu Phone: __________________ Attach appropriate bank statements to prove required funding. (These statements must be either on official bank letterhead paper or signed by a bank official.) Section B. (To be completed by academic adviser)

Academic Program: ___________________________________ Degree level: __________________

1. Reason that extension is required: _____________________________________________________

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2. Briefly describe student’s academic progress: ____________________________________________

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3. Number of credits still required to graduate: __________________

4. Expected completion date for all requirements of academic program: __________________ mm/dd/yyyy

Academic adviser name: ____________________________ Phone: __________________________

E-mail address: ______________________________ Department: ___________________________

Academic adviser signature: ________________________________ Date: ____________________ Updated 2010 G l o b a l E d u c a t i o n O f f i c e - I m m i g r a t i o n S e r v i c e s 817 W. Franklin Street, P.O. Box 843043, Richmond, VA 23284 Tel: (804) 828-0595 Fax: (804) 828-2552