1"
ADMISSION APPLICATION FOR INTERNATIONAL
(F1) STUDENTS
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Fall"(September)(
July"6(
July"30"
Spring"(January)(
November"6"
December"18(
+,,%&=#)&*'(#'$>*2(#'-($*=30"')1(2"="&?"$(#@)"2()9"($"#$%&'"(<&%%(A"(=*'1&$"2"$(@*2()9"(@*%%*<&'5(
1"0"1)"2;(
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Submit"$55"application"fee"(non-refunda ble )-"Fill"out"an"!""#$%&'$()*+,,*+(-./"
B%#="0"')(C"1)&'5.(
All"students"are"required"to"take"a"placement"test"in"English"and"Mathematics"upon"entre"to"the"U.S."with"an"F1"visa"
unless"waived."D'&)&#%%-(#%%(1)3$" ' )1 (<&%%(A"(#== " , )" $ ()* (# ' (E ' 5%&1 9 (%# '5 3 # 5 "() 2# &' &' 5 (, 2* 5 2# 0F(GD4HH "only"unless"you"are"
from"an"En glish "speaking"country."You"may"be"required"to"take"remedial/ESL"or"LINCC"program"based"on"the"results"of"
your"placement"test"before"entering"into"your"degree"program"of"choice."If"you"are"an"F1"student"currently"in"the"U.S.,"
we"recommend"that"you"apply"and"take"a"placement"test"as"soon"as"possible"to"determine"your"eligibility"to"a"degree"
program."
For"more"information"about"placement"test"and"waivers,"please"visit"https://www.ncc.edu/placementtesting/"
Due"to"the"Covid-19"situation"we"are"testing"remotely"using"Zoom."
/3A0&)(E$3=#)&*'#%(!*=30"')1.(
/"=*'$#2-(E$3=#)&*'."Official"secondary"education"diploma/certificate"and"official"transcripts"including"official"
translations"to"Eng lish."In"som e "case s"w e"w ill"reques t"an"ev alua tion "of"you r"sec on da ry"ed uca tion "cred en tials."The "
evaluation"must"be"completed"by"a"professional"evaluation"company."
B*1)(I/"=*'$#2-(E$3=#)&*'.(Official"college"and"university"transcripts"in"a"sealed"envelope."Transcripts"from"non-U.S."
schools"must"include"a"transcript"evaluation"completed"by"a"profession al"evaluation"com pan y."
We"accept"credential"evaluations"from"any"of"t h e"fo llo wing"pro fe ss io n al"c o m p a n ie s:"N A C E S "(e .g."E C E ,"S pa n tr an ,"Wes)"
and"Institute"of"Foreign"Credential"Services."Our"office"reserves"the"right"to"request"an"evaluation"of"all"foreign"
education"credentials"in"order"to"verify"documentation"if"deemed"necessary."
6&'#'=&#%($*=30"')1.
(Please"note"th at"if(it"is"the"applicant's"own"bank"statement,"notary"is"not"required.)"
-Financial"Sponsorship"form"with('*)#2-"and"*2&5&'#%(A#'J(/)#)"0"')"that"is"less"than"3"months"old
-Free"room"&"board"Sponsorship"form"(if"applicable)"with"'*)#2-.""Please"attach"on e "of"th e "fo llo w in g:
K+(,9*)*=*,-(*@(,2*,"2)-()#L(A&%%F($""$F(2"')(2"="&,)(*2(2"')(#52""0"');
B2**@(*@(&003'&M#)&*'.(
(If"you"were"bo rn"on"or "af te r"1 /1 / 1 9 5 7,"a n d "a re "re g ist er in g"f o r"six"or"more"credits,"New"York"State"requires"you"to"subm it"
proof"of"immunization"for"measles,"mumps"and"rubella"(MMR)"or"Titer"(blood"test)"in"order"to"secure"your"registration"
for"classes."You "m us t"also"su b m it"the "requ ired "NY S"m e nin gitis"su rve y.
/3A0&)(DKNO(P#&%&'5(D'@*20#)&*'(@*20(
2"
H*,-(*@(,#11,*2)(&'@*20#)&*'(,#5":
"Your"name"on"your"passport"is"used"for"school"records"and"I-20."
+'(67()2#'1@"2(1)3$"')(@2*0(#'*)9"2(:;/;(1=9**%F(,%"#1"(13A0&)()9"(@*%%*<&'5."
-Copies"of"visa"&"passport"info"page
-Copies"of"a"current"I-20"&"I-94
-Transfer"student"information"page"(pg10).
-Transfer"Verification"Form"(pg11).
+%%(-*32(1=#''"$($*=30"')1(031)(A"("K0#&%()*.(D/+Q66R4HH;E!:(
C9"(*2&5&'#%($*=30"')#)&*'(<&%%(A"(2"S3&2"$(*'(%#)"2($#)"(&'$&=#)"$(A-(*3 2 (* @ @&= " (1 )# @ @;"
Health"insurance"for"F1"International"Student"
It"is"MANDATORY"to "p u rc h as e "H e alt h "In su r a n ce "th r o u g h "N C C ."Y o u "will"be"au to matically "en r o lle d "in "SUNY"St u d en t "H e a lth "
Plan"after"registration."DO"NOT"purchase"a"private"health"insurance"plan"in"or"outside"the"United"States.""""
***"A"Visa"Holder"Other"Than"F1***"
Please"note"that"in"order"for"you"to"study"in"the"U.S.,"you"must"apply"for"an"F1"student"visa."""You"cannot"travel"with"a"B1/B2"visa"to"
study"in"the"U.S.""According"to"the"regulations,"enrolling"in"classes"while"in"B-1/B-2"status"will"result"in"a"status"violation.""""
If"you"are"a lre a d y"in "th e "U . S. "w ith "a "d iff er en t "vis a "o th e r"th a n "a n "F1 "v isa "a n d "want"to"stu d y "a t"N C C ,"y o u "m u s t"reque st"a"virtua l"m eetin g"
with"Ms."Kim"and"make"an"appointment"Eunsil.Kim@ncc.edu"first"so"that""your"eligibility"for"change"of"status"can"be"determined."
When"you"request"your"virtual"meeting"appointment"you"must"include"a"cop y"o f"yo ur"passport"in fo rmation"pa g e" an d"you r"current"
visa"in"it."
3"
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D4CET4+CDQ4+G(/C:!E4C /(
PLEASE"READ"THE"APPLICATION"INSTRUCTIONS"BEFORE"COMPLETING"THIS"APPLICATION"
SEMESTER"FOR"WHICH"YOU"ARE"APPLYING:
(((__"6+GG"(September)"20____((( ((((__"/BTD4V"(January)"20UUUU(
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Last"(Family)_____________________________First_________________________Middle__________________
N; B"20#'"')>W*0"(H*3')2-(+$$2"11.
Number"&"Street"_______________________________________________________________Apt"#__________
City____________________________________Country___________________________
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Number"&"Street)"______________________________________________________________Apt"#__________
City___________________________________"State"___________________________"Zip"Code"_____________
[; W*0"(C"%",9*'"."(______)_______-________ "H"%%3%#2(430A"2."(______)___ _ __ _-________"
\; ]*32(EK0#&%(+$$2"11:_________ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ __
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6. +Z(V"'$"2."""""q"Male""""""q"Female
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q I"have" a"visa" (please"select)"A,B,F,G,H,K,L,M,N,O,P,R,S,T,U,V" and"wish" to"change"my" ____status"to" an"F-1"status
q I"am" applying"for"an" Initial"(first"time)"F-1"Visa"for"NCC"(=*0,%")"(,#5"1(XKc).
q I"am" attending"another"universi ty"or"i nstitution"in" the"U.S."as"an"F-1"student"and"wish"to"transfer"to"NCC
(=*0,%")"(,#5"1(XK77)."!"
""""""""""!All"students"attending"another"US"institution"must"complete"the"Transfer"Verification"Form"found"on"page"8"of"the"application."
d; H*0,%")"()9"(@*%%*<&'5(&'@* 20 # )&*' (#A* 3 )(-*3 2(1,* 31 "(#' $> *2(=9 &%$(Y=9&%$2" ' Z(Q4 G] (&@()9"-(< &%%(=*0 " (<&)9
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c; E)9'&=&)-(#'$(T#="bb.
q Hispanic/Latino"(select"one)
"""""qCentral"American" "qDominican" """qMexican" qPuerto"Rican" qSouth"American" """""""qOther"Hispanic/Latino"
q White"(non-Hispanic) q Black"or"African"American"(non-Hispanic) q Asian"or"Pacific"Islander
q Am erican"Indian"or"Alaskan"Native q Other
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**Information"requested"that"is"marked"with"an"asterisk"(*)"is"voluntary"and"is"used"for"statistical"and"reporting"purposes"only."Information"will"be"kept"
confidential."Refusal"to"provide"this"information"will"not"subject"the"applicant"to"any"adverse"treatment;"nor"will"information"be"used"in"a"discriminatory"
manner."Nassau"Community"College"is"a"comprehensive,"full"opportunity"College,"open"to"all"qualified"applicants"without"regard"to"age,"race,"color,"religion,
marital"status,"national"origin"or"disability."
4"
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q I"p la n "t o "en r o ll"in "th e "L IN C C "(L a n g u ag e "Immers io n "at "N a ss au"Com munity "C o lleg e )"p ro g r am"only.
q I"p la n "t o "en r o ll"in "a "d eg re e "p ro g ra m."
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Program"CODE:"____________Please"refer"to"the"B2*52#01(#'$(+$0&11&*'1(T"S3&2"0"')1(H9#2),"which"can
be"found"on"the"International"Student"Affairs"website."Enter"the"Program"Code"for"the"program"to"which
you"would"like"to"apply."If"you"are"undecided"about"your"specific"program,"enter"LAAA"for"Liberal"Arts."You
may"change"it"once"you"are"admitted."Do"not"enter"a"HEGIS"code.
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1. Name"of"High"School:(UUUUUUUUUUUUUUUUUUUUUUUUUUUUU((Country:(UUUUUUUUUUUUUUUUUUUUUUUUUUUUU
Date"of"Graduation"(MM/DD/YYYY):(UUUUUUUUUUUUUUUUU
2. q"Some"college"level"work"completed q Completed""Associate’s"Degree
q Com pleted"Bachelor’s"degree"of"higher
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)2#'1=2&,)1(<&)9(#'("?#%3#)&*'(@2*0(*'"(*@()9"(=2"$"')&#%("?#%3#)&*'(1"2?&="1(,2*?&$"$(*'(,#5"(7()*.(((
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I"declare"t h a t"a ll"st at ements"made"in "t h is"a p p lic at io n "a re ,"to "th e "b e st "o f"my"kno w le d g e ,"tru e "a n d "co r re ct ."I"u n d e rs ta n d "
that"if"I"was"born"on "or"after"Ja nu ary"1 ,"1957 "and"if"I"enroll"for"6"or"more"chargeable"credits."I"must"provide"the"college"
with"proof"of"immunization"against"measles,"mumps"and"rubella."My"failure"to"comply"with"this"New"York"State"law"
within"30"days"from"the"start"of"the"semester"will"result"in"my"disenrollment"from"classes"without"refund"of"tuition"and"
fees."
In"addit io n ,"w it h "re sp e c t"to "t u itio n "a n d "fe e s,"the"colleg e "m a y "re fe r"a ll"amoun ts "in "a rre a rs "to "a "co lle c tio n "a g en c y "o r"litig a te"
to"ensure"pay m en t"and "I"will"be"resp on sible"fo r"pay m en t"and "all"attorn ey’s"fee s,"reaso na ble "collec tion "costs "and "oth er"
charges"necessary"for"collection"of"any"amount"not"paid"when"due."Further,"I"understand"that"the"college"may"have"such"
default"information"forwarded"to"credit"reporting"agencies."
/&5'#)32"(UUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUU( (((((!#)"(UUUUUUUUUUUUUUUUUUUUUUUUUU(
!
International"A p p lic an ts "to "N a ss au "C o mmunity"Co lle ge "do"not"need"to"complete"TOEFL"exams"to"be"acceptable"candidates"for"adm issio n."En glish"
placement"tests"will"be"administered"after"acceptance"to"the"college"and"before"enrollment."
bbAfter"completing"placement"tests,"you"may"be"required"to"take"remedial"or"LINCC"courses"based"on"results"of"your"placement"tests."Please"refer"
to"Programs"and"Ad m ission s"R equ irem e nts"ch art"p rovid ed "to"see "if"your"intended"major"will"be"affected"by"taking"remedial"or"LINCC"programs.**"
click to sign
signature
click to edit
5"
/C+CEPE4C(Q6(6D4+4HD+G(/:B BQTC(
To"qualify"for"a"Form"I-20,"you"must"prove"that"you"are"able"to"support"yourself"for"every"year"while"attending"school"in"
the"United"States.""Provide"us"with"financial"documents"that"cover"the"cost"of"your"tuition,"living"expenses"(room"&"
board),"books,"supplies,"and"health"insurance.""This"total"may"include"dependents"if"you"have"a"spouse"(husband"or"wife)"
and/or"children"with"you"in"the"United"States.""
Total"E/CDP+CE!"costs"for"the"6+GG(NONOK(/BTD4V(NON7"School"Year:"
C3&)&*'>6""1(b(
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o If"you"ha v e"y o u r"c h ild re n "with"you ,"a d d "fXF\OO"per"child"to"the"total.
* Tuition/Fees"rates"are"subject"to"change"from"the"current"rate.
**"""Nassau"Community"College"2"S3&2"1"students"to"purchase"health"insurance"through"the"college.""You"will
automatically"be"enrolled"for"this"health"insurance"plan.""!Q(4QC"purchase"a"private"health"insurance"plan"in"or
outside"of"the"United"States.
H*0,%")"()9"(@*%%*<&'5(=9#2)()*($")"20&'"(-*32(@&'#'=&#%(13,,*2).(
7; Personal"Funds:""Amount"of"money"in"]Q:T"name
$"
N; Financial"Support:""Money"given"to"you"by"your"sponsor
$"
X; Free"Room"&"Board"Sponsor:"(#(1,*'1*2(<&)9(<9*0(-*3(<&%%(%&?""@2""(*@(#'-(=9#25"Z(les s
$"""7\FOOO"
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The"following"documents"are"attached"to"this"application"to"prove"my"financial"ability"to"Support"myself"for"each"year"of"
study."Due to the Covid-19 situation we are receiving scanned and emailed documents. Originals will
be required on a later date provided by our office staff.
q My"personal"bank"statement.
q Sponsor’s"bank"statement,"pay"stubs"and"Cash"Sponsor"Affidavit"form.
q Sponsor’s"Free"Room"&"Board"Affidavit"with"copies"of"rent"agreement"or"Deed"of"ownership"or"tax"receipt.
6"
D4/CT: HC DQ4/(6Q T (HQ PBGECD4V(B+VE(`(
/BQ4/QTg/(+66D!+8DC(Q6(+44:+G(H+/W(/:BBQTC(+4!(BTQQ6(Q6(6D4+4HD+G(H+B+_DGDC](
hW+C(!QE/(CWD/(+66D!+8DC(PE+4e(
By"completing"this"affidavit,"you"are"swearing"to"the"U.S."government"that"you"will"provide"this"student"with"a"specific"
amount"of"money"from"your"own"financial"resources"for"every"year"of"study"in"the"United"States."You"are"also"proving"
that"you"can"affo rd"the"support"you"are"promising"with"the"documents"you"have"attached."
Before"signing"it,"you"must"understand"that"you"are"making"a"financial"commitment"to"the"student"that"should"not"be"
broken.""Sponsors"who"fail"to"provide"the"promised"support"force"students"to"drop"out"of"school"and"cause"pain"and"
suffering.""Do"not"expect"that"the"student"will"be"able"to"help"support"the"costs"through"employ me nt.""Employm en t"is"
only"allowed"on"campus"and"is"very"limited.""]*3(=#''*)(2"S3&2"(#'-()-,"(*@(1"2?&="()*(A"(,"2@*20"$(&'("L= 9#' 5" (@*2(
)9&1(A"'"@&);(
WQh(CQ(HQPBGECE(CWD/(6QTP.(
1. Fill"this"form"out"completely"in"English.""B2*0&1"(*'%-()9"(#0*3')(*@(0*'"-(-*3(#2"(#A%"()*(5&?";
2. Attach"the"documentary"evidence"of"support"explained"below.
3. Sign"the"affidavit"in"front"of"a"notary"public"or"the"appropriate"official"in"your"country.
PROVE"THAT"YOU"ARE"6D4+4HD+GG](H+B+_GE(Q6(BTQ8D!D4V(CWD/(H+/W(/:BBQ TC(6QT(E8ET](]E+T (Q6(CWE(/C:!E4C g/(
BTQVT+P(Q6(/C:!]"BY"ATTACHING"ALL"THE"FOLLOWING"DOCUMENTS"(if"all"of"these"documents"are"not"attached,"
your"support"<&%%('*)"be"considered):"
Documents"must"be:"
ü A"letter"from"the"bank"with"account"information"&"balance"OR"an"official/original"bank"statement
(Electronic"ban k"sta tem e nts "are" 4QC"accepted)
ü Originals,"less"than"3"m o n th s "o ld"a t"t h e"tim e"o f"app lication
D4/CT:HCDQ4/(6QT(HQ PB GECD4V(B+V E(d(
/BQ4/QTg/(+66D!+8DC(Q6(6TEE(TQQP(+4!(_Q+T!(+4!(BTQQ6(Q6(6D4+4HD+G(H+B+_DGDC](
hW+C(!QE/(CWD/(+66D!+8DC(PE+4e(
By"completing"this"affidavit,"you"are"swearing"to"the"U.S."government"that"this"student"will"live"with"you "fr ee "o f"a n y"
charge"for"room"and"food"for""?"2-(-"#2"he/she"is"studying"and"living"in"the"U.S.""]*3(=#''*)(2"S3&2"(#'-()-,"(*@(1"2?&="(
)*(A"(,"2@*20"$(&'("L=9 #' 5" $(@* 2()9&1(1"2? &=";((You"are"also"proving"that"you"are"the"person"who"owns"or"rents"the"
property"and"can"afford"the"support"you"are"promising"with"the"document"you"have"attached."
Before"signing"it,"you"must"understand"that"you"are"making"a"financial"commitment"to"the"student"that"should"not"be"
broken.""Sponsors"who"fail"to"provide"the"promised"supp ort"forc e"the "stud en ts"to"dro p "out"o f"scho o l"and"ca us e"
unnecessary"hardship.""Do"not""L,"=)(that"the"student"will"be"ab le"to"h elp"su pp ort"th e"co sts"thro ug h"em p loyment.""
Employment"is"only"allowed"on"campus"and"is"limited."
WQh(CQ(HQPBGECE(CWD/(6QTP.(
1. Complete"this"form"entirely"in"English.
2. Attach"the"documentary"evidence"of"support"as"explained"below.
3. Sign"the"affidavit"in"front"of"a"notary"public"or"other"licensed"official"in"your"country.
BTQ8E(CW+C(]Q:(+TE(H+B+_GE(Q6(BTQ8D!D4V(CWD/(/:BBQTC(6QT(E8ET](]E+T(Q6(CWE(/C:!E4Cg/(BTQVT+P(Q6(
/C:!](_](+CC+HWD4V.(
6*2(W*0"*<'"21:"Pho to c o p y "o f"yo u r "d ee d "a n d / o r"ta x "b ill( (((((((((((((((((6*2(T"')"21:"Ph o t o co py"of"rent"re c e ip ts "o r"le a se "a g re e m e n t s"
!*=30"')#)&*'(2"S3&2"$(,2*?&'5(-*3(#2"()9"(*<'"2(*2(2"')"2(*@()9"(9*0"(
7"
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I,"_____ _ __ _ _ _ _ _ _ _ __ _ _ _ _ _ _ ________________,"promise"that"for"each"year"of"his/her"program"of"study"
""""""""""""""""(Sponsor"Name)"
""_________________________________________________________________"will"receive"money"from"me"in"the"
(Student"Name)"
amount"of"$____________________."
""(Please"!Q(4QC"leave"bla n k)"
"Home"Phone"#"(_______)"_______________________" Cell"Phone"#"(_______)"___________________"
Relationship_____________________________________________________________"
(Parent,"spouse,"relative,"friend)"
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8"
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I,"_____ _ __ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ __ ___________"promise"that"__________________________________(
((Sponsor"N a m e)""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""(Student"Nam e )"
and"_____________________________will"live"free"of"any"charge"<&)9(0""in"my"hom e "fo r"e ve ry "year"of"study"that"
""""""""(Dependent’s"Name,"if"applicable)"
he/she"attends"Nassau"Community"College."
Home"Address_____________________________________________________________________________________"
City________________________________"""""""""""""""""""State_________""""""""""""""""""""""Zip"Code______________________"
Home"Phone"#"(______)"_______________________" """"""""""""""""""""Cell"Phone"#"(______)"_______________________"
E-mail"address:"___________________________________________________________
Relationship"to"the"student:"_________________________________________________"
(Parent/Spou se/ Re lative/F rien d)"
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9"
D')"2'#)&*' # %(E$ 3=#)&*'(YDEZ(
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DKNO(P#&%&'5(6*20
How"would"you"like"to"receive"your"documents"and"I-20"package?""(Check"One)"
o Express"Mail"via."E-ship"Global"(Highly"Recommended ):
E-Ship"Global"service"will"allow"you"to"receive"your"I-20"packet"through"DHL"or"FedEx"in"3-5"days."Requesting
your"documents"and"I-20"through"express"mail"is"at"YOUR"expense"and"your"credit"card"(Visa,"Maste r ca r d "o r
Discover"cards"only)"will"be"charged"upon"requesting"the"service.""Once"your"I-20"package"is"ready,"you"will
receive"an"em ail"w ith"d etaile d"info rm a tion .""Onc e"you "rece ive"a n"email"from"us,"ple ase"go "to"E-ship"G lobal
website,"study.eshipglobal.com"to"request"express"mailing"of"your"documents.
o Send"by"USPS"mail:
This"will"take"2-3"weeks"and"it"is"free.""However,"there"is"no"tracking"available.
Please"clearly"print"your"mailing"address:
Name:""_________________________________________________________________
Address:____________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
E-mail:______________________________________________________________________________________
o Pick"up:
If"your"I-20"is"being"picked"up"by"someone"other"than"yourself,"please"provide"the"name"of"the"person"and
phone"number"or"e-mail"so"we"can"contact"the"person"once"I-20"package"is"ready:
Name:""______________________________________"
Phone:"______________________________________"
E-mail:"______________________________________
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Name:"_____________________________________________________________________________________"
Last" " " " """""""First" " """""""""""""""""""""""""""""""""""""Middle"
SEVIS"ID"#:"N______________________"
Current"School"1-20"Expiration"Date:""_______________________"(MM/DD/YY)"
F1"Visa"Expiration"Date:"________________________"(MM/DD/YY)"
(Leave"blank"if"you "d on ’t"hav e"an "F1 "visa "in"yo ur"p ass po rt)"
Do"you"plan"to"travel"outside"of"the"U.S."before"attend ing "NC C ?"
o YES."Please"indicate"your"travel"dates"and"read"the"instruction"below.
From"____________"""(MM/DD/YY)""to"________________"(MM/DD/YY)
o NO.""Please"make"sure"to"complete"your"transfer"by"submitting"admission"application"and"all"required
documents.""Then"you"must"take"a"placement"test"so"that"you"can"sign"up"for"your"classes.
Traveling"outside"of"U.S."while"you"are"transferrin g"to "NC C:"
If"you"are "p la n n in g "to "t ra ve l"o u ts id e "o f"th e "U .S ."b e fo r e"a t te n d in g "N C C ,"p le as e "d o "th e "fo llo wing"A"@*2""you"leave"the"U.S."
In"orde r"fo r "yo u "t o "re e n te r"th e "U . S.,"y o u "will"need "a"t ra n s fer "p e n d in g"I-20"from"NCC.""
Submit"admission"application"and"submit"all"required"documents.
Submit"Copies"of"passport,"visa,"I-20"and"I-94
Submit"Transfer"Verification"Form""(Once"accepted,"your"current"school"must"transfer"your"I-20"out"to"NCC)
Fill"out"I-20"mailing"form"(Page"9)"so"that"we"know"how "you"get"your"I-20."
Take"a"placement"test"(unless"waived)
*If$you$c a n n o t$d o $th e $a b o ve $fo r$s o me$reasons,$please$make$sur e$t o $s p e a k$t o $a n $a d mission$c o u n s e lo r$p r io r $to $y o u r $d e p a rt u re .
11"
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Welcome"to"Nassau"Community"College!"Federal"regulations"governing"students"in"F"status"require"our"office"to"verify"
your"F1"status"from"the"international"student"advisor"of"the"school"you"were"last"authorized"to"attend.""Please"complete"
Part"I"and"then"submit"it"to"your"International"Stud en t"Ad viso r"at"you r"curre nt"sch o ol"for"co m pletio n"o f"Part"II."
B+TC(D.((C*(A"(=*0,%")"$(A-(1)3$"');(
Name:"____________________________________________________________________________________________"
Last/Family"""""""""""""""""""""""""""""""""""""""""""""""""""""""First"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""Middle"
Home"address_______________________________________________City___________State____Zip"Code_________"
Phone"Number"(_______)__________________________"E-mail"address"______________________________________"
Semester"you"intend"to"transfer"to"Nassau"Community"College"__________________/______________"
Fall"or"Spring"""""""""""""""""""""Year"
Student"Signature"_________________________________________________"""Date"_______________________"
(Your signature above indicates that you have authorized the release of this information)
B+TC(DD.(C*(A"(=*0,%")"$(A-()9"(D')"2'#)&*'#%(/)3$"')(+$?&1*2(*2(!"1&5'#)"$(/=9**%(Q@@&=&#%(
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SEVIS"ID"NUMBER:"N__________________________" "Degree"/"Major___________________________________"
Yes" "No"
Did"the"Student"Complete"the"program"for"which"the"I-20"was"issued?
"""""""""Dates"of"Attendance:"""From_________________"To"______________"
"""""Is"the"st u d e n t"in "la w f u l"F-1"status"eligible"to"transfer?
If"the"stu d ent"is"'*)"in"lawf ul"F -1"status,"please"explain:"_____________________________________________________"
__________________________________________________________________________________________________"
__________________________________________________________________________________________________"
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________________________________________________""""________________________________________________"
Name"of"School"Official"/"Title" "Signature"
(______ __ )__ _ __ __ _ __ __ __ _ __ _"""""(___ __ __ _ )__ __ _ __ __ _ __ __ __ _ __ _""""___ _ __ __ _ __ __ __ _ __ __ _ __ __ _ __ __ __ _ __ __ _"
"""""""""""Phone"Number" "Fax"Number" E-mail"Address"of"School"Official
__________________________________________________________________________________________________"
School"Name"&"Address"
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