S.

Department of )
Justice StaiuS - For Academic and Language Students (OMB
NO. 1653-0038)

ed in tbc SEVIS
U.S, Student's
Copy
zf00
First (given)
Name.

Country of
birth:

School OiTicia\ to be notified of student's arrival in U.S.

School address (include

proval ate
ptqmyg qg 01/ 30/ 20 03
code (including 3-digit
This certificate is issued
su to the student named above for:
1'/Pl01#2O00
Mvel of education the student is pursuing ot will pursue
in the United States:

5. The student named above has been accepied for a full course of study at this 8. Ti is school has information showing zc rollowing as ihe student’s
school, majoring in Buatiiass AdminI oera€ i on and ¥ianaqnmen means oL support, estimated for an scsdemic term of months
€, The student is expected to report to the school no later than fUsc the seme numbet of months given in item '7).
o8/2i /zoos and complete studies not later than es /ot/aoia . a. Student's personz\ funds $
The normai length of study is ss b. Funds b‹xn this school S 1 7 , 00O . 00
months. SPeci y tyPe: hchl es t• tsho»ic»ni=
C. Funds from anoiher source $ 12.000 00
6. English proficiency: Specify type: r•=s i i»o •
This nchoo i z•qvi tr•s Eng ¥1sh pr n£t c loncy.
Th• s £u‹$en e hao zha roqu1z•d Eingl Ash prat be1 eucy .

7. his school estimates the student's average costs fpr an academic term of d. On-campus employment 0 00
y (up to 12) months to be: Total 29 OOO 00
a. tuition and fees S . ys y t t 9. Remarks:
b. Living expenses S , s t«n qc
c, Expenses of dependents ( o ) 8 n nn
d, Oder (specify)c: 1ocb1sts, book â e 7p g pp
Totsl S 2 g, 1t s . oe

10.
School Certification: 1 ccrtify under penalty of pojury that all information provided above in items I through 9 was completed before 1 signcd this
form and is tme aad correct; I executed this form in the United 5tates after review and evaluation in the United States by me or other officials of the
school of the student's application, transcripts, or other records of courses taken and proof of financial responsibility, which were received at the school
prior to the execution of this form; the school has detemiined that the above named student's qualifications meet all standards for edmission to the school;
the studcnt will be required to pursue a full course of study as defined by 8 CFR 214./U(6);1 am a designated official of the above named school and
to issue
am this forrri.
auihorized Lend oe•nz Dr receer, quo-

Name of School Official Siture of Desigiuted S hool Official T itlc Date Issued Place Issued {city and suue)

11.
Student Certification: I have read and agrted to comply with the terms and conditions of my adiriission and those of any extettsion of stay as specified
on page 2. I certify that all information provided on this form refers specifically in me and is true and correct to the best of my knowledge. 1 certify
that I seek to enter or remain in the United States temporarily, and solely for the purpose of pursuing a full course of study ai the school named on page 1
of this form. 1 also authorize the named school to release any information from my mcords which is needed by the INS pursuant tn 8 CFR 214.3(g) to
dctemiine
my no immi ant status.

frame of Student Signal tre of Student Dat

Marne of parent or guardian Signature of parent ot guardian Address (city) (Stare or Province) (Country) (Date)
\ £ student under 18
 For Official Use Only
Micro0tm lndex Number
 Page 3

IF YOU NIED MORE INFORMATION CONCERNING YOUR F- l NOKIMMIGRANT STUDENT STATUS AND THE RELATING
[EMIGRATION PROCEDURES, PLEASE CONTACT EFFHER YOUR FOREIGN STUDENT ADVISOR ON CAMPUS OR A NEARBY
IMMIGRATION AND NATURALIZATION SERVICE OFFICE.

SEVIS
FAMILYNAME:
Primary Major: °°.#°°°
Student Emolovment Authorization -
Employment Status: Type:
Duran on of Employwieni - From ( OBte): To (Date):

Employer Location:

Comments:

Lvent History
Event Name: Event Date:

Current Authorizations: Start Date: End Date:

This page when properly endorsed, may be used for reentry of the student to attend the same school after a temporary absence frum the United States.
Each certification signature is valid for one year.

Name of School:
Asotetaut Director, Dnd-
Joho Pommroy orgraduat• Ad&£not one os oi/zoos *ib••x, e
Name of Scheol Official Signafuro of Designated School Offcial Title Date Issued Place Iused (city and state)

Name of School Officia1 Signaun of Designated School Official Title Date Issued Place Issued (city and slale)

Name ef”School Official Signature of Designated Sr5ool Official Tiile Dan Issued Place Issued (cix’ and eta\e)

Sig w=ofDe g=A8chool0Tia Title Date lssuc4 Place Issued (ciiy and stare)

form I -20 A-B tRev. 04-27-88)N