Program Extension Request Form

Program Extension Request

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Name(Required)

First Last

UA Little Rock ID Number(Required)

Visa Type(Required)

Email(Required)

Academic Classification(Required)

Major Area of Study(Required)

Program End Date on Current I-20/DS-2019(Required)

New Program End Date Requested(Required)

Please put the date that you are requesting your I-20/DS-2019 be extended to – the date you plan to graduate from UA Little Rock.

Financial Documentation(Required)

Max. file size: 24 MB.

Please upload financial funding for your extension in the form of a bank letter, current GA letter, or scholarship letter. You can view the required amounts on the International Student Services Program Extension page.

Affidavit of support (if needed)

Max. file size: 24 MB.

If your financial documentation (bank letter) is not in your name, please upload an affidavit of support from your sponsor.

Program Extension Form(Required)

Please attach your filled out Program Extension form with appropriate signatures. To access the blank PDF template visit: http://ualr.edu/international/program-extension/

Max. file size: 24 MB.

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