Davidson County Community College
This form must be completed by all F-1 Nonimmigrant students currently residing in the United States
intending to transfer to Davidson County Community College. The form must be returned before an I-20
can be sent to you.
Please mail or fax the completed for to:
Student Records
Davidson County Community College
P.O. Box 1287
Lexington, NC 27293-1287
Fax: 336-224-0240
Page 1 – To be Completed by Student:
First Name: Last Name:
Phone: Email:
Date of Birth (DD/MM/YYYY):
Semester I plan to enroll (check one):
Fall Spring Year: ________
Name of Institution Last Attended:
Institution Address:
Institution Phone: Institution Email:
Have you taken TOFEL?
Yes No Note: If yes, please provide scores.
I request and authorize my present International Student Advisor or Designated School Official (DSO) to
provide the following information as part of my application to Davidson County Community College
(DCCC). I understand I am not to report to Davidson County Community College unless I have received
an I-20 from DCCC.
Student Signature: Date:
Page 2 – To be Completed by International Student Advisor/DSO:
The international student whose name appears on this form is submitting an application to Davidson
County Community College. We would appreciate you answering the following questions and verifying the
information given by the student on this form. Please return this form via email
Name of Applicant
First: Middle:
1. Does this student currently attend the school that he/she was last authorized to attend by USCIS?
Yes No
2. Would you recommend this student to Davidson County Community College?
Yes No
If No, please explain:
3. What is the student’s visa type and present Immigration Status?
F-1 F-2 F-3 F-4 Other
SEVIS Number:
INS Admissions Number:
I-20 Expiration Date: Date of Birth:
Country of Citizenship:
Name of Institution:
Name of Official/DSO:
Phone: Email:
Signature of Designated/Authorized Official: