INSTRUCTIONS TO THE STUDENT
Only the international student under F-1 status and who is transferring from another SEVIS approved school, college or university within the United States must complete this form.
The applicant must sign and date in Section I: Student Release.  This gives the current Designated School Official(DSO) a permission to provide Moody Bible Institute (MBI) with the student’s immigration i nformation confidentially. The DSO should complete Section II: Transfer Recommendation.
A new I-20 form will not be issued until this form is completed and returned.
SECTION II:  TRANSFER RECOMMENDATION
Type of Visa      (If different from F-1, do not complete this form) SEVIS #
Date student entered:__________________  Degree pursued: ________________________________________________ If an extension was required, indicate the reason :
Was this student ever reinstated during her stay in your institute?  Yes ____ No ______ If yes, please explain:
____________________________________________________________________________________________________ Is this student in legal status with Immigration?  Yes_____ No_____  If no, please explain:
(Attach additional paper, if needed) SEVIS Release Date: ____________________ to Moody Bible Institute (CHI214F00850000)
Please do not release the student’s I-20 without an agreement from our office  if he/ she is in reinstatment process.
Name:  Title:
Institution:  Telephone:
truncated formAddress:
Signature:  Date:
Thank you for your cooperation in helping to complete the application  process with Moody Bible Institute.
PLEASE RETURN COMPLETED FORM WITH THE ABOVE STUDENT’S COPY OF CURRENT I-20 TO:
Mrs. Patcharaporn Prukpitikul / Assistant Dean for International Students
Moody Bible Institute or Fax to :  312-329-4197
820 North LaSalle Blvd.                              Phone : 312-329-4199
Chicago, IL 60610

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