F-1 International Student
Terminated Admission Request

This form must be completed by all F-1 visa holders seeking to transfer to Kalamazoo Valley Community College with a SEVIS record in Terminated status.

NOTE: This form does not guarantee admittance to Kalamazoo Valley. A thorough review of your application materials will be conducted by our office, including, but not limited to, contacting your previous institution to verify the circumstances surrounding your termination.

This form also does not guarantee reinstatement of Active F-1 status. If admitted to Kalamazoo Valley, you must still complete the standard reinstatement application process as adjudicated by U.S. Citizenship and Immigration Services (USCIS).

By signing this form, you are agreeing to the following statements:

You have not been out of status for more than five months
Upon acceptance at Kalamazoo Valley, you are prepared to be enrolled in a full course of study (12+ credit hours) in the next available term
You have the ability to fund a full course study without the assistance of scholarships
You agree to abide by all DHS/ICE/SEVP and USCIS regulations stipulated to regain and subsequently maintain F-1 visa status

Student Information

Student First Name:

Student Last Name:

Phone number:

Email:

SEVIS Number: N00

Previous Institution Information

Previous institution:

Previous DSO name:

DSO phone number:

DSO email:

Termination Information

Date your SEVIS record was terminated:

Personal Statement

1. Please explain, to the best of your understanding, the reason for your termination and the circumstances that led to it.

2. Please explain the steps you have taken to address the situation, including remedies to any issues with funding, ability to enroll full-time, or other barriers that contributed to your termination.

3. Please explain the steps you have already taken or plan to take to prepare yourself for success moving forward. How do you define success?

4. What are your academic goals moving forward? How do you believe Kalamazoo Valley can assist you with reaching these goals?

Signature

Signature:

Contact Information

F-1 International StudentTerminated Admission Request

F-1 International Student
Terminated Admission Request