Attention advisors: please email (mcclennyb@grayson.edu) or fax (903.415.2560) this form to the GCC International student office.

Transfer Clearance Form

This portion to be filled out by the student

Student’s Name __________________________________________________________

                        Last                        First                Middle

SEVIS I-20 ID# __________________________________________

I give permission to my present school to release the information requested on this form.

______________________                               ______________________

Student’s Signature                                Date


This portion to be filled out by the Designated School Official

SEVIS record to be released upon proof of acceptance.  Anticipated release date_______

Please mark all statements that are true about this student:

_____ Student is currently in good standing and is eligible to transfer.

_____ The student has cleared all financial obligations with our institution.

_____ Student is on academic probation or suspension.

_____ Student is on OPT.  Expiration date________________

Students who are out of status or on suspension/dismissal are not eligible to transfer. Please do not transfer student.

_____________________________________________________________

Signature of DSO                Name and Title of DSO                Date

______________________________________________________________

Name and address of institution

______________________________________________________________

Phone                                Fax                                E-mail

Grayson County College

6101 Grayson Dr.

Denison TX 75020-8299

(903) 463-8749 FAX (903) 415-2560