Fill - Free fillable Emergency Regulations Fillable 2019 PDF form

I AM RESPONSIBLE for maintaining my F-1 status and have read the F-1 regulations and college

requirements outlined below.

I am required to have an F-1 visa, valid passport and I-20 form to attend Santa Barbara City College (SBCC).

I must maintain enrollment in at least 12.0 credits per semester.

I must maintain a 2.0 GPA or better and make satisfactory academic progress toward my program of study.

I must obtain permission BEFORE I drop a course that will result in being enrolled below 12.0 credits.

I should read and follow the syllabus (course outline) for the courses I am enrolled in. Attendance is required

to maintain legal status.

I may not enroll in more than 3.0 credits of online courses per semester. Only 3.0 credits of Online/Distance

Education courses will count towards the required 12.0 credits. English Language Program students are not allowed

to enroll in any online courses.

I cannot work off-campus nor engage in any internship, work experience or business while I am in the U.S. unless

I have permission from my Advisor/DSO.

I must apply for a signature on my I-20 from an SBCC Advisor before I travel outside of the U.S.

I must update my address on my SBCC Pipeline account within 10 days of moving.

I must check my Pipeline account e-mail on a regular basis as this is the primary method of contact used at SBCC.

Transfer students: I must complete my transfer to SBCC within 15 days of the start of the semester to receive

my I-20.

I must purchase the school endorsed medical insurance which is included in my tuition fees.

I must obtain permission from an Advisor if I want to study part-time at another school while I attend SBCC.

I must attend classes until the date my I-20 is released to a new school if I request to transfer or decide to end

my studies early.

I must leave the U.S. if I violate my visa status or apply for reinstatement if I am eligible. My Advisor must

notify Department of Homeland Security of my violation.

I must depart from the U.S. within 15 days from my last date of attendance if I do not graduate/transfer/ or apply

for OPT; or 60 days from my graduation date (ESL Certificate/Associate level) or OPT Completion date.

___________________________

Student Signature Today’s Date

Print Your Name page 1

F-1 STATUS: STUDENT RESPONSIBILITIES

Complete page 1 and page 2 and submit with your application.

I should submit a copy of my flight details to my Advisor before I return permanently to my home

country.

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signature

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LIST TWO PEOPLE WHO MAY BE CONTACTED IN AN EMERGENCY. ONE SHOULD BE A PARENT OR LEGAL GUARDIAN. THE

OTHER PERSON MAY BE ANOTHER RELATIVE OR FRIEND WHO KNOWS HOW TO CONTACT YOUR PARENTS OR LEGAL GUARDIAN.

I authorize SBCC representatives to contact the person(s) listed above in case of a legal or medical emergency, and/

or any extraordinary circumstances.

I authorize a representative of the hospital or medical facility, in which I am treated for medical, psychological, or

urgent care, to release information regarding my condition and prognosis to an Advisor/DSO or Program Director at

Santa Barbara City College. I authorize an SBCC representative to release information on my condition to a

hospital/medical facility representative.

I authorize SBCC Health/Counseling staff to provide information to ISSP staff regarding medical treatment, psycho-

logical treatment, and testing reports. I authorize ISSP staff to provide information to SBCC Health/Counseling

staff.

I authorize SBCC representatives to notify my professors if I am in the hospital and unable to attend class.

I authorize my homestay representative, to release, exchange, and / or discuss information regarding my housing

situation with an SBCC representative to ensure the best possible assistance is given if, or when the need arises,

without liability to either party.

I authorize Santa Barbara City College to use my photograph in any and all publications for SBCC marketing and

publicity purposes, including web site entries, without payment or any other consideration in perpetuity. I hereby

authorize SBCC to copy, exhibit, publish or distribute this photo, and I waive the right to inspect or approve the

finished product, including written or electronic copy, wherein my photo appears.

I authorize SBCC representatives to release any information from my records which is needed by Department of

Homeland Security pursuant to 8 CFR 214.3(g) to determine my visa status.

I authorize SBCC representatives to access my I-94 record as needed to verify entry and departure information asso-

ciated with my passport number.

I authorize SBCC representatives to release any information from my records to my referring agency.

I authorize SBCC representatives to contact and discuss with the persons listed above my academic and

immigration status.

I authorize SBCC representatives to release any information from my records to the government agency that

provides funding for my education.

I authorize SBCC ISSP representatives to discuss any pending claims with Ascension Benefits and Insurance Solu-

tions Repres

entatives.

_________

__________________

Student Signature Today’s Date

Print Your Name page 2

EMERGENCY CONTACT & AUTHORIZATION FOR

RELEASE OF INFORMATION

Name:______________________________________

Relationship:_________________________________

Phone:______________________________________

E-mail:______________________________________

Name:______________________________________

Relationship:_________________________________

Phone:______________________________________

E-mail:______________________________________

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