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 |
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.
Last Name
First Name
Middle Name
Student ID/DOB
Country of Citizenship:
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.
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
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:
Name and Title of School Official
Name of School
Zip Code
Telephone Number:
Email Address: