Form I-20 A-B I-20 A-B CERTIFICATE OF ELIGIBILITY FOR NONIMMIGRANT (F-1) STUDEN

DEPARTMENT OF HOMELAND SECURITY

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CERTIFICATE OF ELIGIBILITY FOR NONIMMIGRANT (F-1) STUDENT
STATUS - FOR ACADEMIC AND LANGUAGE STUDENTS
Please read Instructions on Page 2
This page must be completed and signed in the United States by a designated school official.
1. Family Name (surname):
First (given) Name:

OMB NO. 1653-0038
Expires 02/28/2011

SEVIS
For DHS Official Use

Student’s Copy

Middle Name:

Country of birth:

Date of birth (mo/day/year):

Country of citizenship:

Admission number:

2. School (School district) name:

School Official to be notified of student's arrival in U.S. (Name and Title):
Visa issuing post

Date visa issued

School address (include ZIP code):

School code (including 3-digit suffix, if any) and approval date:
_________________________________________ approved on _______________

Reinstated, extension granted to:

3.

This certificate is issued to the student named above for:

4.

Level of education the student is pursuing or will pursue in the United States:

5.

The student named above has been accepted for a full course of study at this
school, majoring in _____________________________________________.
The student is expected to report to the school no later than _____________
and complete studies not later than _______________. The normal length of
study is ______________ months.

6.

English proficiency:

7.

This school estimates the student’s average costs for an academic term of
________ (up to 12) months to be:
a. Tuition and fees
$ __________________
b. Living expenses
$ __________________
c. Expenses of dependents (
)
$ __________________
d. Other (specify):
$ __________________
Total
$ __________________

8.

This school has information showing the following as the student’s
means of support, estimated for an academic term of ____________
months (Use the same number of months given in item 7).
a. Student’s personal funds
$ __________________
b. Funds from this school
$ __________________
Specify type: _______________________________________
c. Funds from another source
$ __________________
Specify type: _______________________________________
d. On-campus employment
$ __________________
Total
$ __________________

9. Remarks:

10. School Certification: I certify under penalty of perjury that all information provided above in items 1 through 9 was completed before I signed this form
and is true and correct; I executed this form in the United States 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 determined that the above named student’s qualifications meet all standards for admission to the school; the student
will be required to pursue a full course of study as defined by 8 CFR 214.2(f)(6); I am a designated official of the above named school and am authorized
to issue this form.
Name of School Official

Signature of Designated School Official

Title

Date Issued

Place Issued (city and state)

11. Student Certification: I have read and agreed to comply with the terms and conditions of my admission and those of any extension of stay as specified on
page 2. I certify that all information provided on this form refers specifically to me and is true and correct to the best of my knowledge. I 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 at the school named on page 1 of this
form. I also authorize the named school to release any information from my records which is needed by DHS pursuant to 8 CFR 214.3(g) to determine
my nonimmigrant status.
Name of Student

Name of parent or guardian
If student under 18

DHS Form I-20 A-B (06/10)

Signature of Student

Signature of parent or guardian

Address (city)

Date

(State or Province) (Country)
For Official Use Only

Microfilm Index Number

(Date)

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Authority for collecting the information on this and related student forms is
contained in 8 U.S.C. 1101 and 1184. The information solicited will be used
by the Department of State and Department of Homeland Security (DHS) to
determine eligibility for the benefits requested.
INSTRUCTIONS TO DESIGNATED SCHOOL OFFICIALS
1. The law provides severe penalties for knowingly and willfully
falsifying or concealing a material fact or using any false document in
the submission of this form. Designated school officials should consult
regulations pertaining to the issuance of Form I-20 A-B at 8 CFR 214.3 (k)
before completing this form. Failure to comply with these regulations may
result in the withdrawal of the school approval for attendance by foreign
students by DHS (8 CFR 214.4).
2. ISSUANCE OF FORM I-20 A-B. Designated school officials may issue
a Form I-20 A-B to a student who fits into one of the following categories, if
the student has been accepted for full-time attendance at the institution: a) a
prospective F-1 nonimmigrant student; b) an F-1 transfer student; c) an F- 1
student advancing to a higher educational level at the same institution; d) an
out of status student seeking reinstatement. The form may also be issued to
the dependent spouse or child of an F-1 student for securing entry into the
United States.
When issuing a Form I-20 A-B, designated school officials should
complete the student's admission number whenever possible to ensure
proper data entry and record keeping.
3. ENDORSEMENT OF PAGE 3 FOR REENTRY. Designated school
officials may endorse page 3 of the Form I-20 A-B for reentry if the student
and/or the F-2 dependents are to leave the United States temporarily. This
should be done only when the information on Form I-20 remains unchanged.
If there have been substantial changes in item 4, 5, 7, or 8, a new Form I-20
A-B should be issued.
4. CERTIFICATION. Designated school officials should certify on the
bottom part of page 1 of this form that Form I-20 A-B is completed and
issued in accordance with the pertinent regulations.
5. ADMISSION RECORDS. Since DHS may request information
concerning the student's immigration status for various reasons, designated
school officials should retain all evidence which shows the scholastic ability
and financial status on which admission was based, until the school has
reported the student's termination of studies to DHS.
INSTRUCTIONS TO STUDENTS
1. STUDENT CERTIFICATION. You should read everything on this
page carefully and be sure that you understand the terms and conditions
concerning your admission and stay in the United States as a nonimmigrant
student before you sign the student certification on the bottom part of page 1.
The law provides severe penalties for knowingly and willfully falsifying
or concealing a material fact, or using any false document in the
submission of this form.
2. ADMISSION. A nonimmigrant student may be admitted for duration of
status. This means that you are authorized to stay in the United States for the
entire length of time during which you are enrolled as a full-time student in
an educational program and any period of authorized practical training plus
60 days. While in the United States, you must maintain a valid foreign
passport unless you are exempt from passport requirements.
You may continue from one educational level to another, such as progressing
from high school to a bachelor's program or a bachelor's program to a
master's program, etc., simply by invoking the procedures for school
transfers.
3. SCHOOL. For initial admission, you must attend the school specified on
your visa. If you have a Form I-20 A-B from more than one school, it is
important to have the name of the school you intend to attend specified on
your visa by presenting a Form I-20 A-B from that school to the visa issuing
consular officer. Failure to attend the specified school will result in the loss
of your student status and subject you to deportation.

DHS Form I-20 A-B (06/10)

4. REENTRY. A nonimmigrant student may be readmitted after a temporary
absence of 5 months or less from the United States, if the student is otherwise
admissible. You may be readmitted by presenting a valid foreign passport, a valid
visa, and either a new Form I-20 A-B or a page 3 of Form I-20 A-B properly
endorsed for reentry if the information on the I-20 form is current.
5. TRANSFER. A nonimmigrant student is permitted to transfer to a different
school provided the transfer procedure is followed. To transfer schools, you should
first notify the school you are attending of the intent to transfer, then obtain a Form
I-20 A-B from the school you intend to attend. Transfer will be effected only if you
return Form I-20 A-B to the designated school official within 15 days of beginning
attendance at the new school. The designated school official will then report the
transfer to DHS.
6. EXTENSION OF STAY. If you cannot complete the educational program after
having been in student status for longer than the anticipated length of the program,
you must request an extension of stay from a designated school official prior to your
program end date.
7. EMPLOYMENT. As an F-1 student, you are not permitted to work off campus
or to engage in business without specific employment authorization. After your first
year in F-1 student status, you may apply for employment authorization on U.S.
Citizenship and Immigration Services Form I-765 based on financial needs arising
after receiving student status, or the need to obtain practical training.
8. NOTICE OF ADDRESS. If you move, you must submit a notice within 10 days
of the change of address to a designated school official at your school. The
designated school official will update SEVIS with your new address.
9. ARRIVAL/DEPARTURE. When you leave the United States, you must
surrender your Form I-94, Departure Record. Please see back side of Form I-94 for
detailed instructions. You do not have to turn in Form I-94 if you are visiting
Canada, Mexico, or adjacent islands other than Cuba for fewer than 30 days.
10. FINANCIAL SUPPORT. You must demonstrate that you are financially able
to support yourself for the entire period of stay in the United States while pursuing a
full course of study. You are required to attach documentary evidence of means of
support.
11. AUTHORIZATION TO RELEASE INFORMATION BY SCHOOL. To
comply with requests from DHS for information concerning your immigration status,
you are required to give authorization to the named school to release such
information from your records. The school will provide to DHS your name, country
of birth, current address, and any other information on a regular basis or upon
request.
12. PENALTY. To maintain your nonimmigrant student status, you must be
enrolled as a full-time student at the school you are authorized to attend. You may
engage in employment only when you have received permission to work. Failure to
comply with these regulations will result in the loss of your student status and
subject you to deportation.
AUTHORITY FOR COLLECTING. Authority for collecting the information on
this and related student forms is contained in 8 U.S.C. 1101 and 1184. The
information solicited will be used by the Department of State and DHS to determine
eligibility for the benefits requested. The law provides severe penalties for
knowingly and willfully falsifying or concealing a material fact, or using any false
document in the submission of this form.
REPORTING BURDEN. U.S. Immigration and Customs Enforcement is
collecting this information as a part of its agency mission under the Department of
Homeland Security. The estimated average time to review the instructions, search
existing data sources, gathering and maintaining the data needed, and completing
and reviewing the collection of information is 30 minutes (.50 hours) per response.
An agency may not conduct or sponsor, and a person is not required to respond to an
information collection unless it displays a currently valid OMB Control Number.
Send comments regarding this burden estimate or any other aspect of this collection
of information, including suggestions for reducing this burden, to: Office of the
Chief Financial Officer/OAA/Records Management Branch, U.S. Immigration and
Customs Enforcement, 500 12th Street S.W. STOP 5705, Washington, D.C.
20536-5705.

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IF YOU NEED MORE INFORMATION CONCERNING YOUR F-1 NONIMMIGRANT STUDENT STATUS AND THE RELATING
IMMIGRATION PROCEDURES, PLEASE CONTACT EITHER YOUR FOREIGN STUDENT ADVISOR ON CAMPUS OR DHS/U.S.
IMMIGRATION AND CUSTOMS ENFORCEMENT.
FAMILY NAME:
Primary Major:
Student Employment Authorization:

Employment Status:
Duration of Employment - From (Date):
Employer Name:
Employer Location:

SEVIS

FIRST NAME:

Student’s Copy

Type:
To (Date):

Comments:

Event 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 from the United States.
Each certification signature is valid for 1 year.
Name of School:
Name of School Official

Signature of Designated School Official

Title

Date Issued

Place Issued (city and state)

Name of School Official

Signature of Designated School Official

Title

Date Issued

Place Issued (city and state)

Name of School Official

Signature of Designated School Official

Title

Date Issued

Place Issued (city and state)

Name of School Official

Signature of Designated School Official

Title

Date Issued

Place Issued (city and state)

DHS Form I-20 A-B (06/10)