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*HCC ID:
SEVIS Form I-20 Application
All fields marked with * 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
date/semester
Change of Educational Level
Student:
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 admission term/semester
Fall
Year
Spring Year
*3. Program Information: Type of degree you are seeking
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Associaattte in Arts (Associaattteee dddeeegggree is dddeeesigggnneeed foorrr tttrannnsfeeerrr tttooowwwaards a hiiggghheerrr ddeegggree in thhhe choooseen progggraammm ooofff stttuudddy)
Associaaattte in Scieeennnce (Associaaattteee dddeeegggree isss dddeeesigggnnneee
d
foor tttrannnsfeerrr tttooowwwaaardsss a hiiigghheerrr ddeegree i
n
the chhooose
n
programmm ooofff stuudy)
Associate in Applied Science: *Major/program of study
Certificate 111 or 22 ::: Specialization
*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 (Last) Name First Name Middle Name
Date of Birth (MM/DD/YYYY) Age
Mailing address:
_
City of Birth Country of Birth Country of Citizenship
Street Apt.# City, Region, Postal Code Country
Address outside the U.S. (Home Country)
Street City, Region, 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.
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5. Dependent Information (Only the 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
• If more than one dependent, please attach additional pages. Additional supporting documents for the
dependents such as marriage certificate, birth certificates and copy of passports (or I-94/
Approval notice for Change of Status applicants) 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. Authorization for information release (optional):
________________________ __________________ __________________________
Name Telephone Email
I consent to the release of information about my application and 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 received 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 student has
an immigration issue that requires legal advice, the student is encouraged to seek outside legal counsel from a qualified
immigration attorney.
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PRIN
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9. The Student’s Role and Responsibilities for Compliance with F-1 Laws and Regulations
T
he 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
load.
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 understand 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 Services & Programs
(ISP).
_ _
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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