J-1 Transfer-Out Form

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J-1 Exchange Visitor Transfer Out Form

This form is intended for current J-1 Exchange Visitors at Texas State University who wish to transfer to another U.S. institution to continue their J-1 program.

To be completed by the Designated Campus Representative at the current institution

Exchange Visitor's Family Name:

Exchange Visitor's First/Given Name:

Exchange Visitor's Date of Birth:

Transfer-Out Effective Date:

SEVIS # (Listed on the DS-2019):

Exchange Visitor Category (intern, professor, etc.):

Campus Representative at TXST:

Email of TXST Campus Representative:

To be completed by the J-1 Exchange Visitor (EV):

Family Name:

First/ Given Name:

I herby authorize Texas State University to transfer my SEVIS record to the new program listed below effective on this date:

To be completed by the J Visa RO/ARO at the new institution:

Name of Institution:

Program Number:

Transfer Effective Date:

Program Objective:

Additional Comments:

RO/ARO Name:

RO/ARO Email Address:

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