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Vance-Granville Community College | Main Campus Admissions Office (Vance-Granville Community College)

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Visa Clearance Form for
International Students
Vance-Granville Community College | Main Campus
Admissions Office | 200 Community College Road | Henderson, North Carolina 27573
(252) 738-3234 Telephone | (252) 738-3356 Fax | registrars@vgcc.edu
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.
SECTION I:
To be completed by applicant.
Last Name
First Name
Middle Name
Student ID/DOB
Address
Country of Citizenship:
State
Zip Code
Date of intended enrollment:
Phone Number
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.
Signature:
Date:
SECTION II:
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 registrars@vgcc.edu.
1. SEVIS Number:
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?
If yes, type/dates:
4. Is this student currently attending the school he/she was last authorized to attend?
If no, please explain:
5. To the best of your knowledge, has this student maintained legal F-1 status?
If no, please explain:
6. Is this student currently expelled, suspended, or have any disciplinary action with your institution?
☐ Yes ☐ No
If yes, please explain:
7. Additional comments:
Signature
Date:
Name and Title of School Official
Name of School
Address
City
State
Zip Code
Telephone Number:
Email Address:
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Vance-Granville Community College Main Campus Admissions Office (Vance-Granville Community College)

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Completed 24 July 2020

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