REQUEST FOR LETTER OF STUDENT STATUS OR
WORK AUTHORIZATION
Please fill out the information below completely. Be sure to print clearly. Allow 5 (five)
days for your letter to be prepared.
Name on I-20 or DS-2019:
______________________________________________________________________________
Family Name
First Name
Middle Name
Current Address: ________________________________________________________________
E-mail:
Phone:
Citizenship: ____________________________________
Male
Female
SEVIS ID #: _______________________ Student ID #:_________________ Visa type
Major:
Circle:
# of Credits Currently Registered For:
Associate
Bachelor
Master
Doctorate
Graduate Non-degree
PURPOSE OF REQUEST:
____ Work Authorization Letter This letter is good for the academic year and following summer.
____ Verify Student Status
This letter will verify your enrollment for given terms.
_____Work Authorization
Name of employer on Campus:_______________________________________________________
_____Student Status Certification
School term to certify for attendance: __________________________________________________
(example: Fall 2006-Spring 2007 or August 2003-May 2007)
_____Want statement included that I am expected to enroll for the
______ Next semester
______Next academic year
I verify that all the above information is correct as required by U.S. immigration regulations.
Student Signature/Date:______________________________________________________________
Received date/by: ____________________________________________
(7/09)
J\Forms\Student Forms\Handout Masters\Status-Work