Fillable Valencia College Application F1 Student

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Valencia College Application F1 Student

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The Valencia College Application F1 Student form is 3 pages long and contains:

  • 4 signatures
  • 2 check-boxes
  • 73 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Valencia College

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1
MM/DD/YYYY
COUNTRY OF CITIZENSHIP EMAIL ADDRESS
COUNTRY OF BIRTHCITY OF BIRTHDATE OF BIRTH
MM/DD/YYYY
q Male q Female
FAMILY/LAST NAME FIRST, MIDDLE NAME GENDER
Applicant Information: Please print your name as it appears on your passport in all capital letters.
PROGRAM INFORMATION * There is no guarantee of a morning or afternoon schedule at either campus.
Class assignments are based on availability.
Start Date: ____________________________________________ q West Campus* q Osceola Campus*
CHECK HIGHEST EDUCATION LEVEL COMPLETED:
q Less than High School q High School Graduate or Equivalent q Technical Degree q Some College
q 2-Year Degree q 4-Year Degree q Master’s Degree q Doctorate Degree
HOW DID YOU HEAR ABOUT US?
q Friend/Family q Valencia College Website q Internet Search q Other: ________________________________________
Planned Length of Study (minimum 4 months): q 4 Months q 6 Months q I2 Months
PAYMENT INFORMATION:
q Visa q MasterCard q Discover q American Express
Name as it Appears on Card: ________________________
Card Number: ____________________________________
CCV #: ___________________________ (3 or 4 numbers)
Relationship to Student: ____________________________
Expiration Date: __________________________________
Amount to Charge: $50.00 USD
I authorize the use of my credit card to pay for the application fee in the amount stated above.
Signature: _______________________________________ Date: ___________________________________________
FOR OFFICE USE ONLY:
Date Received: ___________________________________ CSC Consultant (initials): ___________________________
FOREIGN ADDRESS
Address Line 1: ___________________________________
Address Line 2: ___________________________________
City: ____________________________________________
State/Province: ___________________________________
Postal Code: _____________________________________
Country: ________________________________________
Telephone: _______________________________________
U.S. ADDRESS (IF AVAILABLE):
Address Line 1: ___________________________________
Address Line 2: ___________________________________
Address Line 3: ___________________________________
City: ____________________________________________
State/Province: ___________________________________
Zip Code:________________________________________
Telephone: _______________________________________
INTENSIVE ENGLISH PROGRAM
F-1 Application
MM/DD/YYYY
MM/DD/YYYY
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2
INTENSIVE ENGLISH PROGRAM
Declaration of Finances/Adavit of Financial Support
AFFIDAVIT OF FINANCIAL SUPPORT
The adavit below must be completed by the family member or sponsor and must
match the name of the account holder provided in the bank letter or statement.
Students do not need to complete this section if all financial support comes from personal funds.
Please indicate your relationship to the student:
q Father q Mother q Brother q Sister q Other: ____________________________________
I hereby certify that I, _______________________________________________________ , will be responsible for the educational and/or living
expenses of ________________________________________________________________ each year while he/she is attending Valencia College.
I also certify that the total amount of money I have available for educational expenses at Valencia College is U.S. $ ________________
I authorize the release of my supporting financial documents to verify that the promised financial resources are immediately
available to me and the student. I swear and arm that I know and understand the contents of this adavit, signed by me,
and that the statements are true and correct.
Signature of Sponsor: ________________________________________________________________ Date Signed: _________________
PLEASE READ AND SIGN:
By signing below, I certify that all information in this application is complete and accurate. I have read and understand
the application checklist and cancellation policy (refer to application instructions).
Student Signature: __________________________________________________________________ Date Signed: _________________
NAME OF STUDENT (Please print clearly)
NAME OF SPONSOR (Please print clearly)
International students must submit the information below along with a financial document prior to the issuance of
the I-20.
Acceptable forms of financial documents are recent bank letters or statements, from either the student’s personal
account or a sponsor’s account. Sponsors should sign the adavit of support section to verify they are willing to
use their funds for the student’s educational expenses. A signed copy of a scholarship letter stating the amount
and duration of the award is acceptable.
THE FOLLOWING IS AN ESTIMATE OF EXPENSES FOR AN F-1 STUDENT FOR EACH 16-WEEK PROGRAM:
Description Fees
Application Fee $50
Tuition Fee (16-week minimum) $3,040
Books and Supplies $300
Accident and Sickness Insurance
(six months mandatory) $617
Living Expenses
(lodging, utilities, food, transportation, etc.) $4,000
Total Financial Requirement $8,007
PLEASE NOTE:
Additional family members, such as a spouse and/or child,
will require certification of additional funds in the amount
of $4,000 per dependent. Please submit a copy of each
dependent’s passport.
Do you plan to bring any dependents on F-2 visas?
q Yes q No
If yes, check all that apply.
q Spouse q Children
(please indicate how many children: ______)
MM/DD/YYYY
MM/DD/YYYY
(Required)
APPLICANTS UNDER 18 YEARS OF AGE PARENT/GUARDIAN AUTHORIZATION:
I, the parent or legal guardian of the above mentioned applicant, give permission for the student to participate in the Intensive
English Program and indemnify Valencia College of all liability in the event of personal injury, property damage, property theft or
claims of that nature including damage or injury caused by Valencia College’s negligence, actions or omissions. In the event of an
emergency, I authorize the participant to receive medical treatment for an illness or injury at my own expense. I, the undersigned
parent or legal guardian, arm that I have read and am freely signing this agreement.
Parent Name: _____________________________________________________________ Date: ____________________
Parent Signature: __________________________________________________________
MM/DD/YYYY
(Optional)
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3
INTENSIVE ENGLISH PROGRAM
F-1 Status Responsibility
All F-1 students are responsible for learning, understanding and complying with United States federal laws
and regulations governing the F-1 student visa. Failure to do so will violate your legal status in the U.S.
Please read the information below.
INTERNATIONAL STUDENT AGREEMENT
I, __________________________________________________________, understand that if I am enrolled in the Intensive
English Program at Valencia College as an F-1 student, I agree to maintain my F-1 student status and follow all U.S. Immigration
and Naturalization Service (INS) regulations during my studies. This includes but is not limited to the following:
• Attending a minimum of 18 program hours per week, which consists of 18 classroom hours for every week of the program—if
not, I will be placed on attendance probation for not meeting the immigration requirement
• Maintaining a valid passport and all related documents
• Having adequate funds to meet all expenses during the program
• Carrying medical insurance through Valencia College’s provider, Insurance for Students at: insuranceforstudents.com/valenciaiep
• Adhering to all college policies regarding student conduct and academic procedures
• Maintaining a grade of C or higher in each session in order to continue in the program; otherwise,
I will be placed on academic probation
• Reporting any address change for me or my dependents within 10 days of the change to the DSO
• Completing at least one 16-week program before transferring out to another school
• Failing to comply with any of the above requirements may result in termination of my F-1 visa status
I understand that approximately 30 days before my program end date, I must meet with my international student advisor to discuss
my future plans. I understand that I have three options, outlined below:
1. Program Completion: You have 60 days after your program completion, and then you must leave the country.
Your 60-day grace period begins on the last day of your class, not the end date on the I-20.
2. Program Extension: To extend your program, fill out the Program Extension Form and submit an updated ocial bank
statement (if more than five months old) and proof of insurance 21 days before your program end date.
Failure to do so will cause you to be out of status.
3. Transfer Out: You must complete at least one 16-week program before transferring out to another school. Follow the
instructions on the Transfer Out Form and submit it to the international student advisor no later than 60 days after
your program end date, not the end date of the I-20. If you transfer out before the end of your 16-week program,
you will not receive a refund.
I also understand that if I decide to extend my F-1 visa, I must inform the international student advisor at least 21 days before my
current I-20 expiration date. Program extensions cannot be granted after the expiration of the current I-20. I also understand that
if I register less than one week before any class start date, my space is not guaranteed and it may cause me to be out of status and
potential transfer out to another school.
I also acknowledge that any interruption in my studies (for any reason, including sickness or vacation) may require me to repeat
classes. No refunds or level change requests will be granted for this reason.
I authorize the release of medical information for treatment purposes and give permission to a medical facility to examine me in
case of illness or injury.
OTHER IMPORTANT INFORMATION - All actions below must be approved by the international student advisor.
• Reinstatement: You have 60 days after the completion of your classes to either leave the country, extend your program
or transfer out to an other institution. If you do not submit your paperwork by the end of the 60 days, you will have to apply
for a reinstatement. See the Reinstatement Form for instructions.
• Temporary Leave of the Country: You can depart the U.S. for a temporary absence of up to five months for either medical
or academic reasons.
• Stop Studying: If you decide to stop studying before your program end date, you will not receive a refund for the initial
16 weeks.
• Vacation: Students are eligible to take one month of vacation per year once they complete at least six months of class.
Please consult the Student Handbook and/or the advisor for specific guidelines pertaining to vacation requests.
• Employment: An F-1 or F-2 student attending a language program is not permitted to work (on or o campus)
in the United States.
• Change of Status: If students leave the country, their application will be automatically canceled by USCIS.
I arm by signing below that I have read and understand this information, and I accept full responsibility for maintaining my
status as an international student during the duration of my studies. In addition, I understand the payment requirements and
the cancellation policy.
Student Signature: ___________________________________________________________ Date Signed: ________________________
MM/DD/YYYY
(Required)
© 2018 Valencia College | 18CEI033
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Valencia College Application F1 Student

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Completed 18 July 2020

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