SURNAME/PRIMARY NAME GIVEN NAME SEVIS Sandra
PREFERRED NAME
COUNTRY OF BIRTH BELGIUM
PASSPORT NAME
COUNTRY OF CITIZENSHIP BELGIUM
CITY OF BIRTH Brussels DATE OF BIRTH 20 OCTOBER 1988
FORM ISSUE REASON CONTINUED ATTENDANCE
ADMISSION NUMBER
Class of Admission
F-1
ACADEMIC AND LANGUAGE
SCHOOL NAME
SEVP School for Advanced SEVIS Studies SEVP School for Advanced SEVIS Studies
SCHOOL OFFICIAL TO CONTACT UPON ARRIVAL Mark Twain Immigration Specialist
SCHOOL ADDRESS 126 N WAYNE ST, ARLINGTON, VA 22201
SCHOOL CODE AND APPROVAL DATE BAL214F4444000 03 APRIL 2015
EDUCATION LEVEL
MASTER'S
PROGRAM ENGLISH PROFICIENCY
Required
START OF CLASSES
21 SEPTEMBER 2017
MAJOR 1 Biochemical Engineering 14.4301 MAJOR 2 None 00.0000
MAJOR 2 None 00.0000
ENGLISH PROFICIENCY NOTES Student is proficient EARLIEST ADMISSION DATE 21 AUGUST 2017
PROGRAM START/END DATE 20 SEPTEMBER 2017 - 20 SEPTEMBER 2020
| ESTIMATED AVERAGE COSTS FOR: 12 MONTHS | STUDENT'S FUNDING FOR: 12 MONTHS | ||
| Tuition and Fees | $ 10,000 | Personal Funds | $ 20,000 |
|---|---|---|---|
| Living Expenses | $ 5,000 | Funds From This School | $ |
| Expenses of Dependents (0) | $ | Funds From Another Source | $ |
| Other | $ | On-Campus Employment | $ |
| TOTAL | $ 15,000 | TOTAL | $ 20,000 |
Tuition may increase each year.
I certify under penalty of perjury that all information provided above was entered 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 and the student will be required to pursue a full program of study as defined by 8 CFR 214.2(f)(6). I am a designated school official of the above named school and am authorized to issue this form.
DATE ISSUED
PLACE ISSUED
SIGNATURE OF: Mark Twain, Immigration Specialist
07 February 2020
ARLINGTON, VA
I have read and agreed to comply with the terms and conditions of my admission and those of any extension of stay. 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 program of study at the school named above. I also authorize the named school to release any information from my records needed by DHS pursuant to 8 CFR 214.3(g) to determine my nonimmigrant status. Parent or guardian, and student, must sign if student is under 18.
X
SIGNATURE OF: Sandra SEVIS
NAME OF PARENT OR GUARDIAN SIGNATURE
DATE
ADDRESS (city/state or province/country) DATE