Medical Reduced Course Load Request Form for F-1 or J-1 ... · your Physician’s letter/statement regarding your medical condition and a recommendation for reduced course load. (3)

Medical Reduced Course Load Request Form for F-1 or J-1 Visa Status Holder

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This is form is for an international student who bears F-1 or Fletcher-Sponsored J-1 visa and would like to take less than full-time course(s) due to medical needs. Please read BOTH page of this form. Complete and submit Page 2 to Reiko Ohmura along with a copy of your Physician’s statement recommending you to take less than full-time course load. You need to keep this page for your information.

What You Need to Know about US Immigration Rule Regarding RCL as International Student? (1) Based on your medical condition AND documented by a Medical Doctor (MD), Doctor of Osteopathy or

Licensed Clinical Psychologist, you are eligible to request a “Reduced Course Load (RCL)” for a semester. RCL can be as low as Zero course registration. But, your Doctor and the Fletcher Registrar make a recommendation how many courses/credit hours you to take.

(2) In Zero course registration, your SEVIS record (I-20 or DS-2019 status) will be remained as Active and gives you an option of stay in the United States or back in your home country.

(3) Reiko authorizes your RCL and report to the SEVIS. The authorization is for a semester. If you would need to take RCL more than the authorized period of time, please Reiko Ohmura knows as soon as possible. In order to extend your RCL period, you need to submit a new statement signed by your Physician without exception. Otherwise, you will be in an immigration regulation violation.

What You Need to Do for RCL Request as International Student? (1) Meet Mary Dulatre, the Fletcher Registrar first to discuss the issue (2) Seek your Physician’s letter/statement regarding your medical condition and a recommendation for reduced course load. (3) Provide a copy of your Doctor’s letter to the Fletcher Registrar (4) Submit this form, Medical Reduced Course Load Request Form, along with a copy of your Doctor’s letter to Reiko Ohmura (via email or in-person). Reiko reports your RCL to the US Immigration and Customs Enforcement (ICE, F-1 student) or Department of State (J-1 student) (3) You will get a new set of I-20 or DS-2019 with RCL authorization annotation

You May Need to Extend Your I-20 or DS-2019 Due to RCL You may need to have your I-20 or DS-2019 end date extended due to your RCL in order to meet academic

requirements to graduate. In order to request I-20 extension, you need to submit “Visa Status Extension Request Form” along with a funding document that shows extra funding for the extending period as well as all academic related expenses. Your I-20 or DS-2019 must be extended before its expiration date! Email Reiko to request “Visa Status Extension Form” before your program duration end date.

Medical Reduced Course Load Request Form for F-1 or J-1 Visa Status Holder

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I: Personal Information

1. Last Name: 2. First Name:

3. Date of Birth: 4. Sex: Male Female Prefer Not Identify 5. Tufts ID: mm/dd/yyyy

6. Country of Birth: 7. Country of Citizenship:

8. Passport issued by : 9. Passport Expiration Date: County mm/dd/yyyy

10. Residential Address in the US: Street Apt. / Room #

City State Zip Phone

11. Contact Information While in RCL: Address

City State/Province Zip Phone (For non-US number, Include Country Code)

12. Email Address While in RCL:

II: Program and Immigration Status Information

13. Degree Program: MA MALD MIB LLM Ph.D. MATA Other:

14. Term Taking RCL: semester 15.Number of Credits to Take: credits

16. Anticipated Graduation Term: semester or I don’t know yet

17. Visa Expiration Date: 18. Your Status End Date: mm/dd/yyyy (Your I-20 or DS-2019 Expiration Date)

VI: Acknowledgement by Student

I understand that I am authorized to take reduced course load in semester for now .

I understand that I must contact Reiko Ohmura if and when my Physician recommended me to extend my medical leave of absence period beyond the authorized period of time.

I understand that I need to inform the Fletcher School Registrar as well as Reiko Ohmura when my Physician recommended me to resuming full-time course load taking. I also understand that I need to submit a copy of a statement that issued by the Physician regarding any changes in my medical condition.

I understand that I may need to request visa status (I-20 or DS-2019) extension due to my reduced course load duration in order to graduate from the Fletcher program. I will provide necessary document for extra funding in regard of my I-20 or DS-2019 extension prior to my current I-20/DS-2019 end date.

Student’s Signature: Date: