My SEVIS Record Update

My SEVIS Record Update (F-1 Only)

F-1 students are required by the Department of Homeland Security (DHS) to enroll full-time every term. At Poly Languages Institute, full-time enrollment means 18 or more hours of instruction per week. If you are an F-1 student and wish to request an exception to this enrollment requirement, you must complete this form and receive prior approval from your Designated School Official (DSO).

Please submit this form before the start of the term for which you are requesting a waiver. If the form is not submitted in advance, your SEVIS record may be terminated for “Failure to Enroll.” If you need help completing this form, please contact your student advisor:

• Irvine students: [email protected]
• Los Angeles students: [email protected]

– Step 1 of 2

Personal Information

Student Name *

First

Last

Email *

Email

Confirm Email

Phone *

Date of Birth *

MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Which center? *

• POLY at Irvine
• POLY at Los Angeles

What is your plan? *

• I will continue, but not this term.
• I would like to discontinue.

Last Day of Attendance *

State the last day of the term you are currently attending or have completed. Do not put the last day of your vacation.

Reason for a Vacation *

• Completed 6 consecutive terms
• Just completed a ESL or TOEFL program.
• Medical Reason with Doctor’s Recommendation
• Travel outside the US

If you fall under multiple criteria, select the one criterion that best suits you. In all cases, you must exit the school if you have completed both of our ESL and TOEFL programs.

Period – From *

To *

Supporting Document *

Click or drag a file to this area to upload.

Acceptable file extensions: pdf, jpeg, tiff, gif, png. The file size must be less than 12 megabytes.

Reason for Discontinuation *

• I am transferring to another SEVP approved school.
• I am leaving the US.
• None of the above.

Which programs have you completed? *

• None
• ESL Program
• TOEFL Program
• ESL and TOEFL Programs

Are you in good status? *

• Yes
• No

You are in good status if 1) your last term attendance is above 80% and GPA is above 2.0 or 2) your cumulative attendance is above 80% and GPA is above 2.0.

Do you have an acceptance letter? *

• Yes
• No

Acceptance Letter Required *

• I am submitting an acceptance letter as a proof of my acceptance to the new school.

Acceptance Letter *

Click or drag a file to this area to upload.

Acceptable file extensions: pdf, jpeg, tiff, gif, png. The file size must be less than 12 megabytes.

Start Date on the Acceptance Letter *

SEVIS School Code *

School Name *

School Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

School Contact Person *

Contact Person Email *

Email

Confirm Email

Contact Person Phone Number *

Next

Acknowledgement and Agreement

Required Term After Vacation *

• If I take some time off, a term or more, I understand that I must continue at least one term (4 weeks) at POLY Languages Institute. Otherwise, I understand that I will be terminated from SEVIS for “Unauthorized Withdrawal.” I understand that my last day of attendance at POLY Languages Institute is my last day of the term I was enrolled, NOT my last day of vacation.

Annual Vacation *

• I have completed 6 consecutive terms as a full-time student. I am requesting a vacation for one or two terms (60 days or less).

Time off Before New Program *

• I have completed at least 4 consecutive terms and successfully completed (C or better) the ESL program or the TOEFL program. I am requesting a time off for one or two terms (60 days or less) before I start a new program.

Medical Leave *

• I need to be excused from the full-time registration requirement for medical reasons. I have attached the supporting document(s) from medical professional(s). The number of terms requesting for excuse – due to medical reasons – during my entire studies at POLY is 3 terms or less (90 days or less).

Travel Outside the US *

• I need to travel outside the U.S. or currently outside the US. My absence from the U.S. is more than 30% (7 days or more) for the term I am requesting to be excused. I am requesting to be excused for 4 terms (4 months) or less. I have attached a copy of my plane ticket. I agree to submit a copy of the Form I-94 as a proof of evidence if requested.

Transfer before Completing a Program *

• I would like to withdraw from the ESL program or the TOEFL program. I am transferring to another SEVP approved school. I understand that the start date must be within 60 days from the last date of my attendance – or the sooner date required by the new school. Please release my SEVIS record to the school only if I am in status.

Transfer after Completing a Program *

• I have successfully completed the ESL program or the TOEFL program. Within 60 days of my last day at POLY Languages Institute, I understand that I must leave the U.S., continue on with a new program, or transfer to another SEVP approved school. If I choose to transfer, within 45 days, I understand that I must submit the acceptance letter from another school so that my SEVIS record can be released in a timely manner in status. I also understand that the start date must be within 5 months or the sooner date required by the new school.

Transfer after Completing both Programs *

• I have successfully completed the ESL program and the TOEFL program. Within 60 days of my last day at POLY Languages Institute, I know that I must leave the US or transfer to another SEVP approved school. If I choose to transfer, within 45 days, I understand that I must submit the acceptance letter from another school so that my SEVIS record can be released in a timely manner in status. I also understand that the start date at the must be within 5 months or the sooner date required by the new school.

Transfer Terminated *

• I would like to withdraw from the ESL program or the TOEFL program. I am transferring to another SEVP approved school. Please release my terminated SEVIS record to the new school.

Exit before Completing a Program *

• I wish to withdraw from the ESL or the TOEFL program and leave the U.S. I understand that I have to leave the U.S. within fifteen (15) days of my last day at the school. I understand that I will be terminated in SEVIS for “Authorized Early Withdrawal.”

Exit after Completing a Program *

• I have successfully completed the ESL program or the TOEFL program. Within 60 days of my last day at POLY Languages Institute, I understand that I must leave the U.S., continue on with a new program, or transfer to another SEVP approved school. If I choose to transfer, within 45 days, I understand that I must submit the acceptance letter from another school so that my SEVIS record can be released in a timely manner in status. I also understand that the start date must be within 5 months or the sooner date required by the new school.

Exit after Completing both Programs *

• I have successfully completed the ESL program and the TOEFL program. Within 60 days of my last day at POLY Languages Institute, I know that I must leave the US or transfer to another SEVP approved school. If I choose to transfer, within 45 days, I understand that I must submit the acceptance letter from another school so that my SEVIS record can be released in a timely manner in status. I also understand that the start date at the must be within 5 months or the sooner date required by the new school.

Exit after Terminated *

• I would like to withdraw from the ESL program or the TOEFL program. I am leaving the US and I understand that I have to leave the U.S. within fifteen (15) days from the date I was terminated. Please close out my record from SEVIS for “Authorized Early Withdrawal” if I have not been already terminated for a different reason.

Unauthorized Withdrawal *

• I understand that I will be terminated from SEVIS for “Unauthorized Withdrawal” unless I provide an official document from USCIS to do otherwise.

MyPOLY *

• I have access to MyPOLY and I have verified my records prior to completing this form. What I have stated in this form is consistent with the records stated in MyPOLY.

Certification *

• I certify that what I have stated herein is true. I also understand that if I have not submitted this form in a timely manner, I may have been already terminated for “Failure to Enroll.”

Credit Card Verification Fee *

• Credit Card Verification Fee ($1)

The credit card information you provide will be used to identify the person completing this form. The cardholder’s name must match the name of the student. If you are using a credit card that’s not under your name, you must email us using the email account on your MyPOLY portal indicating the credit card holder’s name.

Total Due: *

$0.00

Assisted by (Optional)

State the name of the advisor who assisted you in completing this form.

Stripe Credit Card *

Card

Name on Card

Previous

Comment

Submit