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All fields marked w
ith * are required and must be completed
*1. I am applying as:
New/Initial F-1 Student:
I live outside the U.S. and want to attend HCC on an F-1 visa.
Transfer International Student:
I am an F-1 student in the U.S., and I want to transfer to HCC
from............................................... (Name of your current school)
Change-of-Status Student:
I am in the U.S. and wish to change my status to F-1.
Defer Attendance Student:
I have already applied to HCC but need to change my start
Change of Educational Level
A current F-1 student at HCC who completed my program and
would like to enroll in another degree plan (AA to AS or AAS)
*2. Specify your new a
dmission term/semester
Year_______ Spring Year_______
Summer Year_______
*3. Program Informatio
n: Type of degree you are seeking
*4. Student information
Please ensure your name is spelled correctly. Per guidelines issued by the Department of Homeland Security
(DHS), the passport has been designated as the official name-giving document. Therefore, please write your
name exactly as it is shown on your passport.
_____________________________ ___________________________ ___________________________
Family (Las
t) Name First Name Middle Name
______________ ______________ ________________
City of Birth Country of Birth Country
of Citizenship
______________________ ____
Date of Birth (MM/DD/YYYY) Age
Mailing address:
______________________ ______ ________________________
Street Apt.# City, Region, Postal Code Country
Address outside the U.S. (Home Country)
______________________________ ________________________ _____________________
Street City, Regio
n, Postal Code Country
Email __________________________ Phone (____) _____ _____
_____I certify that I will have graduated High School by the first day of attendance at HCC.
Student under the age of 18 must provide documentation to prove that he/she has achieved the equivalency of a U.S. high
school diploma in his/her country by submitting a transcript evaluation
along with their application to ISP. Check HCC website
for accepted evaluation agencies.
SEVIS Form I-20 Application
*HCC ID: ___________________________
EEnEnngggllliiish Lsh Lsh Laaannnggguuuaaaggge Te Te Trararaiiinnniiinnnggg
AsAssoAssosociciciaaattte ie ie in Artn Artn Artsss ((Asso(AssoAssociciciaaattteee dddeeegggrereree ie ie isss dddeeesisisigggnnneeed fd fd fooorrr tttrararannnsfsfsfeeerrr tttooowwwaaardrdrdsss a ha ha hiiiggghhheeerrr dddeeegggrereree ie ie in tn tn thhhe che che chooossseeen pn pn prororogggrrraaammm ooofff ssstttuuudddy)y)y)
AssoAssoAssociciciaaattte ie ie in Scin Scin Scieeennnce (Assoce (Assoce (Associciciaaattteee dddeeegggrereree ie ie isss dddeeesisisigggnnneeed fd fd fooorrr tttrararannnsfsfsfeeerrr tttooowwwaaardrdrdsss a ha ha hiiiggghhheeerrr dddeeegggrereree ie ie in tn tn thhhe ce ce chhhooosesesen pn pn prororogggrararammm ooofff stststuuudddy)y)y)
Associate in Applied Science:Associate in Applied Science:Associate in Applied Science: *Major/program*Major/program*Major/program ofofof studystudystudy ___________________________________
Certificate Certificate Certificate 111 ororor 222 ::: SpecializationSpecializationSpecialization ____________________________________
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5. Dependent Information (Only t
he student’s spouse or children under the age of 21 are eligible for
dependent status)
_______________________________ _________________________ __________________________
Family Name
First Name Middle Name
__________________ ___________ ___________ ____________ ________________
Date of Birth (MM/DD/YYYY) City of Birth Country of Birth Country of Citizenship Relationship to applicant
than one dependent, please attach additional pages. Additional supporting documents such as
marriage certificate, birth certificates and copy of passports (or I-94 for COS) will be required for
upload in the passport checklist item.
*6. Financial guarantor’s information:
_______________________ ________________________ ____________________________________
Guarantor’s Name Relationship to applicant Guarantor’s contact information: phone/email
* 7. Permission to pick up or mail SEVIS Form I-20:
Choose one of the following options and provide necessary information:
I authorize my SEVIS I-20 to be:
Picked up
at the
office by:
_____________________ Phone (_____)_______ _________
Email ________________________
Mailed to
___________________ Address ____________________Apt.______
________________State/Province Postal Code:______________________
I consent to the rele
ase of my education records to person(s)/agent listed above. I understand that my education record
includes, but is not limited to, my enrollment and immigration status and financial standing. I am waiving my rights of
nondisclosure of these records under federal law only to the person(s)/organization(s) specifically listed above.
8. Acknowledgement of Responsibilities and Liability Notice
By signing this application below, I confirm that I have recei
ved and read the guidelines outlining the responsibilities for F-
1 students to maintain legal F-1 status in the United States while studying at Houston Community College (HCC). I further
understand by signing below that failure to comply with these guidelines and regulations can and will result in loss of legal
status in the United States. Furthermore, I acknowledge that in consideration and as a condition of my acceptance to
HCC, I have an obligation to meet with an International Student Advisor/Designated School Official (ISA/DSO) at the
Office of International Services & Programs (ISP) for any and all immigration advising related to F-1 issues.
The ISA/DSO is not an “Advocate” or “Representative” for the student in any legal capacity. I understand that ISA/DSOs
and other HCC employees do not provide legal advice to students. Therefore, I hereby release all ISA/DSOs and
employees of HCC of any and all liabilities resulting from the advice given by an ISA/DSO or staff member of the ISP. All
matters relating to the immigration status of the student is the student’s responsibility, not the responsibility of HCC. If a
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student has an immi
gration issue that requires legal advice, the student is encouraged to seek outside legal counsel from
a qualified immigration attorney.
9. The Student’s Role and Responsibilities for Compliance with F-1 Laws and Regulations
The U.S. Federal Government regulations state how international F-1 students must maintain legal status. Failure to
follow these regulations could result in your F-1 status being terminated. The brief outline below provides an overview of
the student’s responsibilities for maintaining status in the United States while studying at Houston Community College.
Maintain all F-1 related documentation, including a valid passport and the SEVIS I-20 Form.
Maintain your contact information. Students must maintain their email addresses, phone numbers and mailing
addresses in the HCC student self-service system at all times.
Notify ISP of any change in information, including academic major/program, demographic and legal
information, within 10 days of the change.
Be enrolled in a degree-seeking program and make satisfactory academic progress toward completion of this
program by following the HCC degree plan. Students must maintain a minimum GPA of 2.0.
Courses audited or graded “W” and “FX” will not count towards enrollment.
Be enrolled full-time (at least 12 semester credit hours) unless authorized in advance to take a reduced course
Only 1 Distance Education (online) class counts towards the required 12 semester credit hours.
Only the summer semester is considered a vacation semester. However, if the summer semester is the initial
semester for a student, he/she must enroll in at least 9 semester credit hours in that first summer semester.
Submit an extension request no later than 45 days before the SEVIS Form I-20 expires.
Depart the U.S. in a timely manner (within 60 days) after completion of your program.
Work only with the appropriate authorization. Follow the guidelines posted by ISP to apply for any
employment-related benefits. Work no more than 20 hours/week at an on-campus job while enrolled full-time. Any
employment without prior authorization is considered illegal.
Have a valid travel signature/endorsement on your SEVIS Form I-20 before leaving and re-entering the U.S.
If necessary, complete an income tax return per Internal Revenue Service (IRS) regulations by the filing deadline
of every year.
Check the ISP website regularly for information and updates.
Check your To-Do List regularly in the student (self-service) online account.
Activate your HCC email account after your initial registration and check it regularly.
Once enrolled in classes, be automatically enrolled in and charged the premium for the HCC international student
health insurance plan each semester based on the health insurance eligibility requirements.
*10. Please print, sign and date your application
I certify that I under
stand sections 1-9 and that all information provided is complete, accurate and true.
Furthermore, I
understand that all changes requested must be submitted in writing to the Office of International Student Services& Study
Abroad (OISS&SA).
_________________________________ ________________
Name (please print) Signature Date (MM/DD/YYYY)
We thank you for your interest in Houston Community College. You have made an excellent choice to further
your education, and we look forward to serving you and meeting your educational needs.
The information on the Houston Community College (HCC) Office of International Services & Programs (ISP) website is intended only for current and prospective international students, faculty and staff
affiliated with HCC. All matters relating to the immigration status of the student is the student’s responsibility, not the responsibility of HCC. If a student has an immigration issue that requires legal
advice, the student is encouraged to seek professional services from a qualified immigration attorney. Any information on ISP's website is subject to change at any time and without notice and may
not apply to individuals outside HCC. Nothing contained herein should be constructed as giving legal advice as contemplated under any statue, regulation, or other law.
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