International Student and Scholar Services
Request for Concurrent Enrollment Form
A. To Be Filled Out By Student:
Last Name
First Name
Student ID#
Email Address
Phone Number
Birth Date
Degree (BS, BA, MS, JD, PhD)
Major
Do you have a previous request for
concurrent enrollment? Y / N
Please initial:
_____ The combined credits for which the student is enrolled are the equivalent of a full course of study during all
required terms for your degree. Failure to maintain full time enrollment will result in termination of the
student’s F-1 visa status and subject you to deportation.
_____ Official transcript proving completion of the courses at the concurrent school listed above must be submitted to
the International Student and Scholar Services within two weeks after the end of the semester.
_____ Students using concurrent enrollment must take courses which apply to the student’s degree plan. Consult with
your academic advisor.
_____ Must be in good status.
_____ The student must be enrolled [taking classes] at StMU during required terms for your degree. StMU must issue
and maintain the SEVIS I-20, handle all SEVIS reporting requirements, and ensure that the student is pursuing a
full course of study.
_____ The StMU ISSS Office will issue a new I-20 documenting the concurrent enrollment, based on evidence that the
student's enrollment in both institutions is the equivalent of a full course of study. The name of the other
(concurrent) school where you are enrolled must be clearly recorded in the remarks section (page 1, item 9) of
your I-20.
_____ If you decide to enroll at a different institution for concurrent enrollment, you are required to notify ISSS. In
such case, you must submit the concurrent form again.
I have read and understand the above responsibilities.
Student’s Signature
Date
(Don’t forget to fill out page 2)
__________________________________________________________________________________________________
Please Return To:
Office of International Students and Scholar Services
Chaminade Tower, Ground Floor Room 105
210-431-5091
Revised: January 2014
Page 2
B. To Be Completed By Academic Advisor:
Above named student will enroll in the following courses at:
College/ University
Class Start Date
Course #
Course Title
Please check:
 The student is taking prerequisite courses
 The required course is not available at StMU
______
Academic Advisor (Print Name)
Academic Advisor’s Signature
______
College/ Department
Date
C. Designated School Official Signature:
Approved
Print Name
______________ ______
Signature
_________
Denied
__________________________
Date
__________________________________________________________________________________________________
Please Return To:
Office of International Students and Scholar Services
Chaminade Tower, Ground Floor Room 105
210-431-5091
Revised: January 2014