I-20 Extension Request Form

I-20 Extension Request Form
Note to the Advisor
This form ensures compliance with U.S. immigration regulations. The form must be completed for an
F-1 student to receive additional time to complete his/her program of study. Please complete this
form in full, attach a degree audit, and return it to the ISO.
Note to the Student
The ISO cannot process this request if you are out of status or have a past-due balance on your
account.
PART I – To be completed by student
International Student Office
international@austincc.edu ♦ www.austincc.edu/support/international
Last Name
Student ID #
First Name
SEVIS ID # N000
Email Phone #
PART II – Academic Advisor’s Report
To be completed by a designated international student academic advisor/counselor
Please indicate the most appropriate reason that applies to this request:
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)
No unusual delay. The original length of time given to complete studies is not applicable for a
student in this field of study
Studies interrupted by documented medical condition (attach physician’s statement)
Other compelling academic reasons (please explain)
When is this student expected to complete his/her studies ____________________________
Please attach a degree audit.
ADRE.068.0412

I hereby recommend this student be granted an extension of stay until the date specified above to
allow sufficient time to complete
Advisor’s Name
Advisor’s Signature
Email Phone #
Date
For ISO Use ONLY
Approved
Not Approved
Comments: ______________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
ADRE.068.0412