I-20 RELEASE FORM

How would you like to receive your I-20?

Please note: Documents will be delivered by the information entered below. If there is a
change to this information, contact International Services immediately.
___ Mail to my home country address (San Jacinto College does not express mail documents).
___ Mail to my U.S. /local address
___ Mail to U.S. address of family or friend:
Name: _____________________________________________
Address:_____________________________City______________________State____ Zip
Code________
___ Pick up in the Educational Planning and Counseling Office at my designated campus.

Information Allowing Release of Your Records

To allow anyone, other than yourself, access to any of your records, we require your written permission
to do so. We must receive this form before anyone can pick up any documents, including your I-20 and
acceptance letter, from San Jacinto Community College District on your behalf.

I give permission to allow the following person access to my student records during my application
process:

Name _______________________________________________________________________________

Texas Driver’s License Number________________________________

U.S. Phone Number ____________________________________

By signing this document, it is understood that you are giving us permission to allow the above stated
person access to your student records on your behalf.

Please understand that this I-20 Release Form is only valid until you, the student, present yourself for
the first time to the Educational Planner or International Counselor at which point this document is null
and void.

Student Last Name (surname)

_____________________________________________________________
Student First (given) Name
__________________________________________________________________
Date of birth (month/day/year)____________________________________
Student SJC ID # G00________________________

Signature of Student______________________________________________________
Date:_______________
Please send all forms to: below

SAN JACINTO COLLEGE SOUTH

INTERNATIONAL SERVICES Revised 06/30/2016
13735 BEAMER ROAD, S-6.120
Revised 06/30/2016