1. 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: _____________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
2. Briefly describe student’s academic progress: ____________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
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
Global Education Office - Immigration Services
817 W. Franklin Street, P.O. Box 843043, Richmond, VA 23284 Tel: (804) 828-0595 Fax: (804) 828-2552