F-1 Student Re educed Cou urse Load ( (RCL) Requ uest Form

This form is to be used by stude u ents to reques approval for Reduced Co urse Load (RC enrollmen from the U-M st r CL) nt M national Cente If this is a Final Term RCL, you may drop your re er. y equest at the IC front desk. To submit aca ademic or Intern medical RCL reque ests, call 734.6 647.0658 to ar rrange a meeting with an ad dvisor.
NAMEFIRSTNAME MIDD DLENAME LASTN UMID#

DATEO OFBIRTH(mmdd dyyyy)

GENDER FEMALEMALE

NUMBE ERofF2DEPENDE ENTS

UNIQNAME

TELEPH HONE

DELIVERYMETHOD PING OPTIONS ) PICKUPSHIP(SeeSHIPP

SEVISID# N

Impo ortant notes. Please read. P Read the Reduced Cour Load infor R rse rmation on the IC website bef fore completing this request fo g orm. Full time is 12 credits for undergraduate students, 8 cr s e redits for gradu uate students o 6 credits for g or graduate stude ents with GSI/GSRA A/GSSA 50% appointment. You must either be full-tim enrolled or approved for RCL by the Dro e me R op/Add deadline set by the Un e niversity Regist trar each term. If you want to withdraw from a course which will cause you to be less than full time after the Drop/Add deadline, you must be t w e s approved for RCL before dropping the course. f c Failure to gain RCL appro g oval will cause loss of F-1 sta atus and termin nation of your S SEVIS record. Once this request is appr r roved, a new I-2 will be issue to you with t RCL autho 20 ed the orization on Pag 3. ge

Chec cklist of requir documents red s. C Copy of the fr ront side of yo current I-94 card our 4 C Copies of you previous and current I-20 (pages 1 & 3) ur ) A unofficial transcript dow An t wnloaded from http://wolver m rineaccess.um mich.edu/ A letter written by a license medical or osteopathic doctor or licen ed d nsed clinical psychologist (for medical r reasons) or by y a academic advisor (for ac an a cademic reaso ons) following the instructio on the IC website. g ons

Read the statemen below, sign and date. d nt I certi that I have read the reques form instruct ify r st tions and inform mation in full, a to the best of my knowled and dge, the informa ation I have provid is accurate I understand that I must have U-M approv health insu ded e. d ved urance for the d duration of my F status and that if I have F-1 any d dependents, the too must have health insur ey rance. I also un nderstand that I must report a address change through Wolverine Access es s within 10 days of an change in cu n ny urrent (U.S.) or permanent (ou r ut-of-U.S.) add dress. ature _______ _____________ ____________ _____________ ____________ _______ Signa Date __________ e _____________ _________

To be completed only by ISSA e o Academic term ________ t __________ Number of cre edits enrolled _ _____________ ________ Check one reason for RC and specify. e CL RCL for Academ Difficulties [8 CFR 214.2(f R mic [ f)(6)(iii)(A)] (M Must be enrolled at least tim d me). (Specify.) Initial difficulties with English languag E ge Initial d difficulties with reading requir rements erican teaching methods Improp course plac per cement Unfamiliarity with Ame Medical Reason [8 CRF 214.2 M ns 2(f)(6)(iii)(C)] Completion of co ourse of study [8 CFR 214.2(f)(6)(iii)(C)] Program C Completion Dat __________ te: _________

ShortenYes____ _________mm/dd/yyyy No
Date: ____ _____________ _
m:/icall/icpdf/iss ss/RCL/f-rclreq 603 E. Madison Ann Arbor MI 48109-1370 734.764.9310 f 734.647.2181 icenter@umic 7 fax 1 ch.edu www.internatio onalcenter.umich h.edu rev 08/10 lk

ISSA initials: _____ A _________

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