Chemeketa requirements statement
Please read and sign
International programs will be allowed to use the above information for purposes of processing the following services: admissions,
immigration, medical and/or other items provided by the program.
The college is obligated to disclose information to the U.S. Immigration and Customs Enforcement Agency through the electronic
system called SEVIS (Student and Exchange Visitor Information System).
The following academic requirements are based on college and federal policy governing international students on an F-1 visa.
They apply to you once you are admitted. If you do not meet these requirements, it may result in academic probation or dismissal.
Failure to comply with items related to the USCIS ruling governing F-1 student status could aect your status with the U.S. Depart -
ment of Immigration.
Each student must complete a minimum of 12 credit hours with a 2.0 GPA each term or 18 hours per week
(non-credit), with the exception of one term a year which is considered a vacation term. A vacation term only occurs after
courses may not apply.
Each student must complete his/her study in an appropriate timeline, as printed on the I-20, or request an extension.
3. Each student must inform Chemeketa of his/her current address, phone and e-mail within one week of change.
4. Each student must participate in the orientation and Student Success process, which will include a registration workshop,
classes, and supplemental instruction advising. All international students will take placement testing upon arrival. All stu -
dents will take or successfully challenge required Orientation classes.
5. Students are required to attend Chemeketa for at least one term before transferring to another school. This rule applies
when the student enters the USA using a Chemeketa I-20. If a student enters with Chemeketa’s I-20 but chooses to attend
another school, their record at Chemeketa is cancelled. In that case, the student is free to either-
a) Request a transfer of their terminated I-20 record to apply for reinstatement or
b) Obtain an initial I-20 from the new school and leave the USA and re-enter with the initial I-20 from the other school
Health Insurance Requirements
Each student is required to obtain illness and accident insurance through Chemeketa that meets the requirements listed below.
Prior to registration the insurance premium must be paid in full No insurance coverage is provided until full payment is received:
ximum: Coverage payable at 100% after $20 co-pay.)
• $50,000 for medical evacuation: (If you become ill or have an accident and need to be sent home for care, this will pay for
• $25,000 for repatriation of remains: (If you die because of an accident or illness, this pays for the return of your body to
• Insurance coverage is applicable anywhere in the world including the student’s home country.
• Insurance must remain active from date of arrival in the U.S. until date of departure or transfer.
• All funds payable in the U.S.
By signing this form, I certify that I have read, understood and agree to the terms and conditions listed-
• Academic requirements: (see above)
• Health insurance requirements: (see above)
• Chemeketa Community College release of information: Chemeketa releases only very limited information regarding a student’s:
enrollment status, dates of enrollment, degree or certicate, program of study, athletic status, or honors awarded.
• I certify that all statements on this application are complete and true.
• I understand that submitted materials will not be returned.
Student signature _____________________________________________________________Date __________________________
Chemeketa International Programs
Internationaladmissions@chemeketa.edu | 1.503.399.2527 Desk |1.971.719.7893 Cell | 1.503.365.4768 Fax
www.chemeketa.edu/international | 4000 Lancaster Dr. NE, PO Box 14007, Salem, Oregon 97309 USA
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