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 Month Day Year Host Family Number*Please enter a number from 1 to 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?*PermanentTemporaryNew Host Family Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code No PO Boxes. We need the physical home address. New Host Family Phone*New Host Family Email* School Number*Please enter a number from 1 to 3.Is this the first or second school? School Name*School Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name of Person Reporting* First Last Name of Person Reporting Zip Code*Email of Person Reporting* Change of Home Code*OTABCDEFGHIChange 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 InformationEmailThis field is for validation purposes and should be left unchanged. Δ
