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: NOO Educational Level: [7] Associates [] Bachelor [] Master [| 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 $. Funds provided by: (Dept./School) (J Other (must attach proof): Amount$ 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): (J! verify this student is making normal progress toward the completion of his or her degree, and | recommend this student's stay to be extended as indicated above. OR (J | 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 I-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 L] Leave of absence (J Other ESL STUDENTS ONLY “Supporting departmental letter NOT required. Please extend student's |-20. Student will continue ESL study until / /20. Academic Advisor's Signature: Date: Name (typed or printed): Phone: Department: Email: International Student Services 79 5 Avenue, 5!" Floor New York, NY 10003 Phone (212) 229-5592 Fax (212) 229-8992 150 West 85" Street, Lobby New York,NY 10024 Phone (212) 580-0210 Fax (212) 580-1738 ISS@NewSchooledu S:MSSSHARED\ISS Forms\REV_Certificate of Program completion.doc-Revised TS 10/21/2010 EFTA00282134