International Student Application Addendum

PREVIOUS ENROLLMENT INFORMATION

Please read this form carefully and sign it in the space provided. Then present it to the International Student Advisor at the college you attended most recently.

I, *

,grant permission for the information (Print Student’s Name) requested below to be forwarded to Becker College.

*

(Student's Initial) (Date)

This section must be completed by the International Student Advisor at your previous school.

TO THE INTERNATIONAL STUDENT ADVISOR:

The student named above is applying for transfer to Becker College.

Please mail your reply to the Admissions Office, Becker College, 61 Sever St, Worcester, MA 01615-0071

1. Date of graduation or termination of study?

2. Was the student pursuing a full course of study?

Yes
No

If no, please explain:

3. Is the student in current F1 status?

Yes
No

4. Has the student met all financial obligations to your school?

Yes
No

If no, please explain:

5. To your knowledge, has the student met all obligations to the Immigration and

Yes
No

6. Admission/Departure Number on 1-94:

7. Did this student receive authorization for:

Full-time Curricular Practical Training
OPTIONAL Practical Training

Full-time
Part-time

8. We would appreciate any comments you think may be helpful to us:

Advisor's Name

FirstLast

Title

Institution:

Phone

Address

Street AddressCityState / Province / RegionZIP / Postal CodeCountry

Email

Date

I. Personal Information

Name*

FirstLast

Address*

Street AddressCityState / Province / RegionZIP / Postal CodeCountry

Phone Number*

Fax

Email*

Country of Citizenship*

Place of Birth (Country)*

If you are currently in the U.S., please give date of entry

Type of Visa*

Expiration Date*

If F1, last date of attendance at previous institution

II. English Language Proficiency Requirement

Is English your primary language?*

Yes
No

Have you completed the Test of English as a Foreign Language (TOEFL)?*

Yes
No

If no, anticipated TOEFL date

If yes, TOEFL test date

TOEFL Score

III. Declaration of Finances

The enclosed Declaration of Finances form should be accurately and completely answered to enable us to complete your I-20 (Certificate of Eligibility). The college is required by U.S. immigration authorities to carefully check the financial ability of each student prior to issuing the 1-20. This will be presented to the U.S. consular office in order to obtain a student visa.
A letter from a bank official on official stationary and signed by a bank officer is required from all sponsors of the student. NO faxes will be accepted. This letter(s) must indicate that there are total minimum financial resources of $40,693 available to the student for the first year of education at Becker College.

Becker College and the United States Citizenship and Immigration Services (USCIS) require that international students provide proof of financial support to cover your tuition, fees and living expenses for the duration of your stay. We will be unable to provide you with the documents necessary to obtain your visa without verification of adequate funding. (Please refer to the attached estimated budget for the breakdown of fees and for the minimum required academic year.)

All sources of support which you submit must be:*

Original, not photocopies
Shown in U.S. Dollars
Prepared for Becker College specifically, no other college or university
No more than one year old
Written in English

Section I.

Please complete personal information for yourself and the person(s) providing financial support for your education.

A. Student’s Name:*

FirstLast

Student’s Address (No PO Box addresses are acceptable):*

Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeCountry

B. Parent’s Name:*

FirstLast

Parent's Address*

Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeCountry

C. Sponsor’s Name:*

FirstLast

Sponsor’s Address:*

Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeCountry

Relationship of Sponsor to Student:*

Please attach a separate sheet of paper and include the above information if there is more than one sponsor (not including parents) for the student.

Section II.

Enter the expected amount of annual support from the sources listed below. Enter amounts in U.S. dollars. Please print all entries. Use an additional sheet of paper for explanations, if necessary.

A. Personal or Family Savings*

U.S.$

Name of Bank where held:*

B. Parents – money available from sources other than savings*

U.S.$

Source*

C. Sponsors – money available from sources other than parents*

U.S.$

Name of Bank where held:*

Section III.

Please complete the following.

A. Does your government currently impose restrictions on exchange and release of funds for study in U.S.?*

Yes
No

If yes, please describe restrictions:

B. Do you have a source of emergency funds once you arrive in the U.S.?*

Yes
No

If yes, name the source:

Amount available in U.S.$*

C. What is the total amount of money you expect to have when you arrive at this institution?*

D. Do you plan to remain in the U.S. during the summer?*

Yes
No

E. Do you have funds available to you during the summer?*

Yes
No

Section V:

This form must be signed by all parties listed in Section I.

I certify that the information on this form is true, correct and complete. I understand that any misrepresentation may be cause for refusing or revoking admission.

The electronic signature consists simply of your name, typed by you on your keyboard. The signature is your confirmation that the application you have filled out is your own work and the information is factually true. Once you type in your name and the date, this will count as your electronic signature.

Name of Student:*

FirstLast

Date*

IV. F-1 Student Visa Information

Upon commitment to Becker College, an I-20 with instructions on how to apply for an F-1 student visa will be sent. Arrival and orientation information will be sent upon receipt of your deposit.