EFTA00282134.pdf

THE NEW SCHOOL F-1 (I-20) PROGRAM EXTENSION REQUEST/ PROGRAM COMPLETION TO BE COMPLETED BY STUDENT Last Name: First Name: Email: New School ID: N00 Educational Level: ❑ Associates LI Bachelor U Master U Doctorate Major: Source of Funding for Requested Period of Extension Please submit financial documents only if requesting a Program Extension. ❑ Personal Funds: (attach proof: bank statement or letter, etc) ❑ Scholarship Amount $ Funds provided by: (Dept./School) ■ Other (must attach proof): Amount$ Source TO BE COMPLETED BY ACADEMIC ADVISOR Date at which ALL degree requirements are anticipated to be completed (mm/dd/yyyy): [ ] Fall _/_ /20 [ ] Spring _/_/20_ [ ] Summer _/_/20_ Advisor Certification (Please check applicable option): ❑I verify this student is making normal progress toward the completion of his or her degree, and I recommend this student's stay to be extended as indicated above. OR ❑ I verify this student is expected to complete all degree requirements for his/her program of study by the date indicated above and will be completing at the end of this semester. (Note: Courses and final theses/projects are requirements for a program of study. Graduation ceremony is NOT a requirement.) Reason Extension is needed (Only for students requesting 1-20 Program Extensions): Please provide supporting departmental letter or email explaining compelling academic circumstances for extension This student has not yet completed the current course of study due to: ❑ Delay caused by a change in major field of study ❑ Delay caused by change in research topic ❑ Delay caused by unexpected research problems ❑ Leave of absence ❑ Other ESL STUDENTS ONLY 'Supporting departmental letter NOT required. Please extend student's I-20. Student will continue ESL study until _/ /20 Academic Advisor's Signature: Date: Name (typed or printed): Phone: Department: Email: - International Student Services 795'^ Avenue, 9h Fbor New York, NY 10003 Phone (212) 229-5592 Fax (212) 229-8992 150 West 85'1 Street Lobby New York, NY 10024 Phone (212) 580-0210 Fax (212) 580-1738 ISS@NewSchooledu SAISSSHAREMISS FormAREV Cenificate of Program completiatcloc-Revised 75 10/21/2010 EFTA00282134