International Student Services 657-278-2787/Fax 657-278-7292

international.fullerton.edu

F-1 INTERNATIONAL STUDENT’S PROGRAM EXTENSION REQUESTInternational students on F-1 status have a "program end date" on the SEVIS I-20 issued by the CSUF International Student Services Office. If an F-1 student is unable to complete his/her program of study by that date, the student must request an extension of his/her program by using this form. Eligibility: F-1 students who maintain lawful F-1 status may apply for a program extension from the ISS office if:1. SEVIS I-20 has not already expired;2. Delay in completing academic program requirements has been caused by (a) compelling academic reasons;

or (b) compelling and documented medical reasons. NOTE: Delays caused by academic probation orsuspension are not acceptable reasons for program extension.

To Apply: Submit/Drop off this form with required financial document to International Student Services Office before posted deadline. No appointment with International Student Advisor is needed. SECTION 1: To be completed by F-1 Student Name:

Last/Family Name First Name CSUF ID# SEVIS #

U.S. Address:

Phone: City State Zip code

Email: (check one)

First /Second/Third Extension Request

SECTION 2: To be completed by Student’s Academic Advisor This form confirms that the above named student is making satisfactory progress toward his/her degree program. Furthermore, my selections below serve as guidance for the duration of this extension request, but not the sole determining factor: (Please check any items below that apply.) For Undergraduate Student: To be completed by AAC Advisor or Graduation Specialist:

For Graduate Student (check all that apply):

Student completed all GE requirements.

Signature of Advisor Date

Student completed all graduate course requirements Student met EWP Requirement (if applicable)Student is working on project/thesis. Student needs to take comprehensive exam(s).

Ver. 03/2017 Scroll down for Section 3

Advisor Name Extension #

To be completed by Major Advisor or Graduation Specialist:

Advisor Name Extension #

Student needs semester(s) to complete the above

and therefore needs until semester.

Signature of Advisor Date

Advisor Name Extension #

Signature of Advisor Date

Term/Year

Comments:

Student needs semester(s) to complete the GE courses

and therefore needs until semester. Term/Year

Student needs semester(s) to complete the major courses

and therefore needs until semester. Term/Year

Student completed all Major course requirements

Or

Or

SECTION 3: SPONSOR INFORMATION Check here if sponsored by your Government or embassy

residing at Name of sponsor Street and number

City State Postal or Zip code Country certify that I will assume full financial respon-

 

sibility, including educational and living expenses for the above named student while he or she is enrolled at Cal State Fullerton.

Date (month/day/year) Signature of sponsor Relationship of sponsor to student

SECTION 4: FINANCIAL INFORMATION (Please provide proof of financial support) A. Either attach the sponsor’s financial document(s). The bank statement and/or letter must be dated within the last six

months and clearly show:1. Name and address of the bank institution with the name of the account holder.2. Current available balance in U.S. dollars.

Acceptable Financial Evidence: Financial documents may include the following: Saving or Checking account Certificate or Time Deposits with the maturity date in the future

Most recent monthly bank statement(s) must be dated within one year. Foreign bank statement and/or letter with English translation and showing amount in U.S. dollars.

Letter of Financial Support or Financial Guarantee document from Government Sponsors or ForeignEmbassies which specify California State University as the student’s school, and validity period of financialsupport.

Official scholarship Award letter from sponsor for student receiving Scholarships.B. Or, have a bank official fill out the Bank Certification section below the chart:

Your financial document must show at least this amount

*BusinessGraduate

*Non-BusinessGraduate

Credential DoctorateAccelerated MS Undergraduate

based on 12 units per semester

in Software Engineering

Tuition and fees (Two semesters)

$16,358 $20,276 $15,416 $14,900 $19,286 $21,315

Living expense (Includes Med.

Insurance) $23,332 $23,332 $23,332 $23,332 $23,332 $23,332 

Total (1 Academic Year) $39,690 $43,608 $38,748 $38,332 $42,618 $44,647

1. Selected Business Graduate includes: MBA, MS in Accountancy Information Systems, and Taxation. 2. Full-time MBA is a 16-month accelerated degree program. Costs are approximated for 12 months based on 2 semesters and 1 summer. 3. All other Graduate Programs. *Based on 9 units per semester. Note: Fees are subject to change

Bank Certification (This section must be completed by a bank official)

Name of depositor: Relationship of depositor to student:

Account type: Checking Savings Other Date opened: (month/ day/year)

Current balance: $ in U.S. Dollars Today’s date: (month/ day/year)

Bank name: Bank seal or stamp (required)

Bank address:

Name of Bank official:

Signature of bank official:

Total (1 Semester Only) $19,845 $21,804 $19,374 $19,166 $21,309 $22,324

Total (1 Sem. GS700 ) $12,066 $12,066 N/A $12,066 $12,066

+ 1 Dependent ($6,000/per) $45,690 $49,608 $44,748 $44,332 $48,618 $50,647

+ 1 Dependent ($3,000/per) $22,845 $24,804 $22,374 $22,166 $24,309 $25,324

+ 1 Dependent ($3,000/per) $15,066 $15,066 N/A $15,309 $15,324