SEVIS Change of Address Report

Country Contacts should use this report when their inbound students move from one host family to the next.

Use the form below to file the report.

Student Name*
First Last
Student Email*
Home Country*
SEVIS Number*
Prior Host Family Names*
Move Date
MM
DD
YYYY
Host Family Number*
Please enter a value between 1 and 5.
Is this the second, third or fourth host family?
New Host Parent Name 1*
First Last
New Host Parent Name 2*
First Last
If no second parent, enter n/a Additional documentation is needed to approve a single parent household prior to placement
Permanent or Temporary Host Family?*
New Host Family Address*
Street Address City State ZIP Code
New Host Family Phone*
New Host Family Email*
School Number*
Please enter a value between 1 and 3.
Is this the first or second school?
School Name*
School Address*
Street Address City State ZIP Code
Name of Person Reporting*
First Last
Name of Person Reporting Zip Code*
Email of Person Reporting*
Change of Home Code*
Change of Home Code Title Description O Other: Reason not listed here; use of "other" requires sufficient narrative description; T Temporary to permanent: Home was temporary/arrival/welcome home; A Alleged inappropriate host family behavior: Allegations of inappropriate touching, sexual advances, adult behavior making student uncomfortable, abuse, or neglect; list date reported to Department; B Student behavior issue: Host family sought removal of student from home because of student's behavior; explain behavior; C Change of school: Change of school required change of home; explain why student changed schools; D Death or illness: Host family member dies or is ill; E Environmental disaster: Flood, hurricane, etc.; F Financial circumstances: Family cannot afford to host; G Geographic reasons: Student wanted more rural/more urban/etc. placement; H Quality of home: Physical home environment was unsuitable; explain circumstances; I General incompatibility: Host family and student not compatible; explain incompatibility;
Change of home code description*
Additional Information
Comments
This field is for validation purposes and should be left unchanged.