Department of Homeland Security i ), Certificate of Figiblity for Nonimmigrant Student Status U.S. Immigration and Customs Enforcement ‘OMB NO. 1653-0038 SEVIS ID: NO022302885 {SURNAMEIPRIMARY NAME GIVENNAME, [Ciass of Admission lpRerERRED NAME PASSPORT NAME. lcounrey oF pint ‘COUNTRY OF CITIZENSHIP K - I za INDIA. ferry oemern, DATE OF BIRTH. 0¢ FEBRUARY 1990 HCANENGC AND! lroum issue REASON ADMISSION NUMBER LANGUAGE feoursxuzo xoTENDARCE exzse7se10s ‘SCHOOL INFORMATION {CHOOL NAME ‘SCHOOL ADDRESS bniversity of arkansas at Little Rock 2601 3. University Ave, Tducation 101, Little Rock, AR {CHOOL OFFICIAL TO CONTACT UPON ARRIVAL ‘SCHOOL CODE AND APPROVAL DATE lbiroctor of International student services 14 PEBRUARY 2003 PROGRAM OF STUDY. _ a z fepucATION LEVEL. ‘MAJOR ‘MAJOR? fexsran's Compete and znfornation Seieness, tone 00-0000 lpeoGRAM ENGLISH PROFICIENCY ENGLISH PROFICIENCY NOTES. EARLIEST ADMISSION DATE. lneqaizea Stusent ip proficient 30 caceunea 2016 Istanr or cLasses PROGRAM STARTAND DATE fos"aawoany 2007 03 JANUARY 2017 = 11 DECENRER 2018 FINANCIALS [NSTIMATED AVERAGE COSTS FORD MONTES ‘SHODENTS FUNDING FOR 9 NONTES uition and eas 5 14,000 personal Funds 5 « Living expenses 9,000 uunds frou This School 5 vedical tsucance, textbooks, miscella $4,000 ‘on-Canpus Bnploynent 5 prove. 7,000 TOTAL 2 28,88 REMARKS SCHOOL ATTESTATION cenit der penalty of jury tll inforaton provided above was ened before [signed this frm and ist and core executed hs fom nthe United [ites ew aad eelason in te Urata Staten by me or rics he sche 0 hesndent'aplion teas oor red of couses ake Js atari pms, ch erent th seal ic ih ent ofthis frm The el is deerme at tee aed ers [sige schol ade student wil be equied to purse afl propre of sucy ns defined by & CER 216206) fa a ptm to nt orm DATE ISSUED PLACE ISSUED 02 suay 2020 nsetle Rocks AR STUDENT ATTESTATION [save red and aged to comply with he eas and conaions cf my amision and tows of ry exension of ay Loe that all frmation provided on this rm fs specially to me end is tue ad eonet othe best my kxvedge. Teel Ua eck to ener oc emai in te United States tsmporry ard solely forthe lurpoe of prsing afl progr of ty st te schol named sbave. Tale thoi te med schol tslesze ty tneration fom my recasneaed by DHS [pursuant of CFR 21433) to determine my nonimmigrant sts, Parea or guardian, and student, ust signif student i under 1. x IGNATURE OF Ane Shand Wathar DATE x NAME OFPARENT OR GUARDIAN ‘SIGNATURE ‘ADDRESS (ciate or provneecouairy) DATE ICE Form 1-20 (04302021) Page 1 of 3Department of Homeland Security 1-20, Cenifcate of Eligibility for Nonimmigrant Student Status U.S. Immigration and Customs Enforcement (OMB NO. 1653-0038 SEVIS ID: NO022302885 (F-1) NAME: Anish Chand Mathur EMPLOYMENT AUTHORIZATIONS _ _ 7 frvre FULLPARTITIME STATUS ‘START DATE END DATE lecew or rou Tae rPRowEo 28 JANUARY 2020 27 ghMUARY 2022 EMPLOYER INFORMATION [iver ‘AUTHORIZATION DATES EMPLOYER NAME, START DATE END DATE cory @stare Ablee GLE 17 MARCH 2070.26 JUNE 2020 BIPFLE ROCK, AR lanowr. 226 20 savonny 2020 16 MARCH 2020 © WAlnagton, DB CHANGE OF STATUS/CAP-GAP EXTENSION, AUTHORIZED REDUCED COURSE LOAD ‘CURRENT SESSION DATES [CURRENT SESSION START DAT WIA. Stade “CURRENT SESSION END DATE 5 on post-completion practical, traintn: ‘TRAVEL ENDORSEMENT This page when propery endowed ray be used for ever Of ade to aid te ame shoo afar atamporry absense ro te United Sas Bask doses valid for one yew, Designated School Official THTLE SIGNATURE DATEISSUED PLACE ISSUED x x x ICE Form 1-20 (04/30/2021) Page 2 of 3Department of Homeland Security U.S. Immigration and Customs Enforcement 1.20, Certificate of Eligibility for Nonimmigrant Student Status ‘OMB NO. 1653-0038 ___—a—a—a—a—=—E>_——rE INSTRUCTIONS TO STUDENTS, STUDENT ATTESTATION. You should read everything on this page ‘ofl, Be sre tht you understand ths terms sed condions ceering Your “Stmisson and yin he United Stas a anoniamigran student boxe sing {he stant stesation on page 1 of the For -20 AB. The a ovis severe penalies for nowingly and nll ftjing or eonoelinge matrilf, o ‘hing a ise document inthe subnsion f this fore, FORM 1.28, The For 1-20 (is form) isthe primary documento show that you have Been admitted to schoo! in the United Stes ad that you ae “tha o apply for aniston othe United States nF clase ofan You must have You Form 20 with you al es. If ou lose your Fama 1-2, youmst reqs a nev on fom your deslgnated schoo official (DSO) at he hol rane on your Frm -23 VISA APPLICATION. You must give this Form 120 tothe U.S, consult officer atthe tine you apply fora vise (unlest 90u ace exempt fom vise ‘eauement), Ie you have x For 120 fom more han ae tho, be sie © preseathe Fo 120 fr the soe! you plano atend, Your vis ill alae {he name of that school, and yw rust ited that Sebool upon eaorng he ‘Untied States, You tua als provide evsence of support fr fio and Tes suing expests wae you asin the United Stats. ADMISSION. Whea you enter the United States, you must present the {lowing document the ote: ate pet of erry) Form (20,2) aval Fl vials you ate exsupt ren veg eguroments) 3) vais passport, ad 4) evidence of ugpot for tation and Tees al ving expenses We You re the United Sates The agent should rum ll cine you bef yo eae the mgpssten sen REPORT TO SCHOOL NAMED ON YOUR FORM I-20 AND VISA. Upon yur fist en tothe Unied Stes, You must repo to tho DSO a the schol sme on your Form (29 and your Fo visa (anes you we exempt fom visa requirements), Iryou decide to ated anode shoal before you ent the Unted States, you tit pretent Form 120 ftom the nave sche to 2 U.S. conor oer fr anew’ Fl visa tat names tbe nov shoal. Fale to enl ine shoo, by Be program srt ate en you Foes 12D may reat inthe Loss ‘tyr stent ss al sje yuo deporion EMPLOYMENT, Unisw:l enploymeat i the United Stasi a reason for terminating your F-1 sats and deporting yo fom the United Stites. You may be employed on camps et your ssbno Vou may be employed at-canpus ‘cuticle practical raining (CPT) you have writen permission for yout [BSO Vou may apy US. Czensip ad immigration Servier (USCIS) fr ‘ofeampas employment authorization inthe sreumstances 1) employment ‘mth an ternal epuniain, 2) 2oves end unexpected eccnare ashi, {nd 3) optional pact taining (OPT) related to your degree, You must hate ‘iienathoaton rm USCIS ble you begin work Carta: our DSO for Usti, Your spouse ce child (€-2 slaseticaton) may ot work te United Sues PERIOD OF STAY, You may rein in he United States whl aking a ful ‘coue of soy or ding shorn’ ergot afer Your progr. F- stats tds and you ae cequted to leave the United Sats onthe eaiiex: of the feloring date) he progr ene eae on Sour Fors £20 us 60 day 2) he ‘nd date of your OPT pls 60 de, ov 3) te texanation of Your program for Sty othr oason Conte yourDSO fr deais EXTENSION OF PROGRAM. Ifyou corso complet th ecvaton progam ‘by the program end dts on poge 1 of your Farm 120, you shoud cnt your [DSO ea 15 day btoe the rogram er dae to request anextesion [SCHOOL TRANSFER. To trantfe choos, Set naily the DSO a the hoot Youare ening of yur pasta tarter thon bin a For 20 frm the DSO tthe school yor plant ten Keir he Form 120 forthe ne schoo 0th [DSO at that sgheol within 15 cys ata boginnng tenance a he nee sho. ‘The DSO wil thn pot te tansfr to the Deperiment of Homeland Se=usty (DHS). You mist enol in the pew school athe wax session start date The DSO at be nw ehoa! must update your pation in SEVIS ICE Form 1-20 (04/30/2021) NOTICE OF ADDRESS. When you srrive i the United Stes, you must report your U.S tess to you’ DSO. If yau move, you mus nly yeur DSO. Di yout new addons within 10 Saye ofthe ange Of addess. The BO will Update SEVIS wath your now aes REENTRY. F-stolents may leave the United States andrews within a period of tive mons To tem, yout hae: 1) avai paso, 2) a valid = tent vib (ues you sr excogt om vi reqierens) 3) your For [page 2, propery enfosed free ty your DSO. Tryou have been ou of the Una Sts for more than fe months, coat your DSO AUTHORIZATION TO RELEASE INFORMATION BY SCIIOOL. DiS Fequtes your school to provide DHS with you are, county of ih, current dress immigration stats, and ceri oer formation cn regula bast tipo request. Your signature onthe Form -20suborizes the noed Schoo 10 ‘leas sch information om yur rea PENALTY. To maintain your nonmmgtantstdent stats, you must 1) femain a fill-tine student at your authorized eehool.2) engage only in Suthorzed eeployment; and 3) keep your passport valid Faure comp ith Sov reponse ok nt maou sas satis bet out egotton INSTRUCTIONS TO SCHOOLS Failure to comply with 8 CFR 214.308 and 8 CFR 2144 when suing Forms I. 20 wil sujet you and you schoo criminal prosecution IF you sue his fm improper, provice Ilse snformstion, ofl a subatraqutred epors, DUS may withdrew it ceetiflection of your school for altendanee by nimi tas, ISSUANCE OF FORM 1-20, SOs my istue a Form 1-20 for any ‘onimgzan your school has aeceptod fora fl couse of sy i that person 1) plan to apply ta enter the Urited Sues in F-1 status, 2) inthe United ‘Seles an Fe! noinmigrant and plan ante you Shoo! ar 3) 3 ‘United Stats end lappy to change nniniarat satus 19 F1. DSOs may flo sue the Foran I-20 fo the spose shld (ander te age of 21) of en Fel ‘Sent tous to eter cr ern the Unie Sates a rs F-2cepencent SOs sign her nda the Glo af page I ofthe Foam 30 t atest that the form i complaed al sal Inaceordnce wih rogulatins ENDORSEMENT OF PAGE 2 FOR REENTRY. Ir there hive been a0 substasve changes in infarmtion D8Os may endrse page 2 of the Form 20 forthe stadere andr (he F-2 dependants wo veal the United Sates I there fave bean elstatve changes, to DSO shuld issu od sign anew Fors 1-20, tha incads those cages RECORDKEEPING, DS ray reques information encering the student's ration situ fr various reasons: DSOs should retain al evidence of ‘ahd inaaealesourees on which admission was based, ut ten’ end completed sina AUTHORITY FOR COLLECTING INFORMATION. Authrity for ‘oleting he information on tis and related Stent fosns is contained in 8 USCC {Ibl sod 118 Tee Deparment of Sti and DES tse Ue nromnatin etre eligibility forte bene requested Te lav rode ove penalties {ortnowingly and wlfly fasting or enoeting a ater ft or sing fale doeunent he vorission ofthis fom [REPORTING BURDEN. US, Inmigtion sd Customs Enforcement colli this information pat of ts sgency sion ude he Deparment of Homeland Secunty The eotinted average tne to roview the metruetons, ah ing ‘sta sources, gather and mainein the needed dla, and complete and review Ge ‘allestion of bem 30 nines (90 hous) pe response. An agen ay tt ona © spansor and a person eat eqhed fo espn oan fora oleeon unite frm displays a cunts vale OM Conve number, Send ‘Sonment eurding ths aden estimate oun edhe aspect of this callin of Inforation naludingsnggetons for edacng this burden, co: Odie ofthe (Chie information Officer ons Maxagemet Bran, U.S. Immgmation and stor Enircemert 8011 Stee NW Stop 580, Washington, DC 20836- 5800 Do not sen he fom 6 his ass. Page 3 0f3