Visa Clearance Form for
Vance-Granville Community College | Main Campus
Admissions Office | 200 Community College Road | Henderson, North Carolina 27573
(252) 738-3234 Telephone | (252) 738-3356 Fax | firstname.lastname@example.org
This form is to be completed by transfer students only!
Please ask your current institution to complete this form as a part of your application process. This form is to inform
Vance-Granville about your current F-1 status. This is not a request to transfer-in your SEVIS record.
To be completed by applicant.
Date of intended enrollment:
I request and authorize my present International Student Advisor to provide the information below as part of my application for
admission to Vance-Granville Community College.
To be completed by the International Student Advisor at your current institution. Please return this form to the
Admissions Office at the above address or email@example.com.
2. Program level/time limit the student has most recently been authorized to pursue:
3. Has this student requested and/or been authorized to accept off-campus employment?
4. Is this student currently attending the school he/she was last authorized to attend?
5. To the best of your knowledge, has this student maintained legal F-1 status?
6. Is this student currently expelled, suspended, or have any disciplinary action with your institution?
Name and Title of School Official