The University of
Montevallo
International Student
Transfer Clearance Form

The United States Department of Homeland Security requires this office to have the following information in order to
process your transfer to the University of Montevallo.  Please complete the information in Section 1 and submit this
form to the DSO at your present or most recently attended school in the U.S.

Section I.
Student Name:_________________________________________________________________________________________
                                         (Surname/Family Name)                      (First or Given Name)                                   (Middle Name)
1.  Academic term and year you will begin your studies at UM:____________________
2.  I authorize my present School's DSO) to provide the information below:

____________________________________________________________        _____________________
                                                               Student’s signature                                                                           Date

Section II  – To be completed by a DSO at your present or last attended school in the U.S.
The above named student has applied for admissions to UM.  Your assistance is appreciated in completing this
section below and returning this form with a copy of the student’s current 1-20 and I-94 to: 

University of Montevallo
Office of Admissions
Palmer Hall, Station 6030
Montevallo, AL 35115
Tel. (205) 665-6030   Fax (205) 665-6032 

Admission (I-94) Number _________________________   Student’s visa type: ________________________ 

Please Mark the appropriate statement: 

_____  The student is in good standing and is/has been pursuing a full course of study.
_____  The student is out of status and a reinstatement to student status was filed on  (date) _________ with the
              (place) ____________________________ service center and is pending. (Please enclose copies of
              documents filed)
_____  The student is out of status.
_____  The student is currently under practical training. Please list all periods of authorized practical training
              (curricular or optional) if known ______________________________________________________

Signature of DSO: ________________________________________  Date: ________________________

Printed Name of DSO: _____________________________________ Email: ________________________
Institution: ____________________________________________ Telephone Number: _________________
Address:________________________________________________________________________________                                                     Street                                                        City                                                     State                                  Zip

DSO E-mail address:_____________________________________________________

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