F-1 Status Change Notification Form

Submission of this form to the International Education department is not required if your last attendance at Shoreline Community College was more than 2 years ago.

Last/Family Name*

First/Given Name*

Student ctcLink ID Number*

Email Address*

Provide email address you preferred to receive email from F-1 Specialist.

I am currently in Active F-1 status.*

Yes No Not sure

Please pick the category that applies to your situation.*

My Adjustment of Status application has been approved. My Adjustment of Status application is pending.

Please upload a copy of change of status approval notice.*

No File Chosen

File uploads may not work on some mobile devices.

Please upload a copy of receipt for Adjustment of Status application.*

No File Chosen

File uploads may not work on some mobile devices.

Signature Statement

I acknowledge that International Education staff recommended that I consider seeking appropriate legal counsel regarding whether it would be more advisable for me to maintain my F-1 status until my Adjustment of Status has been approved. However, I have decided to give up my F-1 status. I hereby notify the International Education department that I am giving up my F-1 status based on having applied for a change of status. I understand International Education staff will update my SEVIS record status as necessary.

Signature Statement*

I hereby notify the International Education department that I am giving up my F-1 status based on having applied for a change of status. I understand International Education staff will update my SEVIS record status as necessary.

Signature (Type)*

First Name

Last Name

Date*