Dear John,
Congratulations! You have been admitted to our Liberal Arts and Sciences program at Queensborough
Community College for the Fall 2015 semester. I am confident that you will make a valuable contribution to
QCC and look forward to welcoming you to campus.
Our nationally recognized Queensborough Academies will provide you personalized support services based on
your academic interests and future goals throughout your academic career at Queensborough. Please visit our
website at qcc.cuny.edu to learn more about our Queensborough Academies and our various support services
available to help you succeed at QCC.
Please take a moment to carefully review the following information:
•
•
•
•
Confirm your Enrollment: Confirm that you will be joining us by completing and submitting an
Admissions Response Form. Your Admissions Response Form is due within 2 weeks of this acceptance.
To submit your Admissions Response Form and for information,
visit http://www.qcc.cuny.edu/admissions/committmentDeposit.html.
Center for International Affairs, Immigration, and Study Abroad: For detailed information and
assistance regarding obtaining/transferring your SEVIS record, please contact the Center for
International Affairs, Immigration, and Study Abroad at isc@qcc.cuny.edu.
Testing: You may be required to take one or more parts of the CUNY Skills Assessment Test. If testing
is necessary, you will receive notification. You may also follow up with the Office of Testing at 718631-6358.
Services for Students with Disabilities: If you need accommodation(s) due to a disability, please
contact QCC’s Office of Services for Students with Disabilities (SSD) located in room S-13 or call 718631-6257.
On behalf of all our faculty and staff, I would like to welcome you to Queensborough Community College.
Sincerely,
Laura Bruno
Assistant Dean of Enrollment Management
Queensborough Community College
Application for the Immigration Certificate of Eligibility (Form I-20)
International students who are admitted into a degree program at CUNY will need to obtain an Immigration
Certificate of Eligibility (Form I-20), in order to enter and/or remain in the U.S. as an F-1 student. This
requirement applies whether you are a new student, a transfer student from another U.S. university, or a student
transferring between CUNY colleges. (Please type or print clearly with a pen)
1
2
NAME
as in passport
PRIMARY
RESIDENCE
(Address)
3
4
5
6
7
8
10
Smith
John
Surname
321 Drury Lane
First Name
Liverpool, Lancashire
Number and Street
(555)-555-5555
CONTACT
INFORMATION
City, State
Cell Phone
01/01/1990
DATE OF
BIRTH
Male
Female
Second given, or middle name Sex
United Kingdom
L1
Country
Postal Code
jsmith@gmail.com
Fax Number
Email
Place Liverpool, United Kingdom
of
Birth City and Country
United Kingdom
Month/Day/Year
United Kingdom
COUNTRY
Country(ies) of Citizenship
321 Drury Lane
PERMANENT
OVERSEAS
ADDRESS
Number and Street
123 Main Street
MAILING
ADDRESS IN
U.S.A. (if known)
Country of Residence
Liverpool, Lancashire United Kingdom
City, State
Flushing, NY
Number and Street
City, State
Fall
2015__
Spring 20___
EXPECTED
SEMESTER OF
ENROLLMENT
DID YOU
COMPLETE
HIGH SCHOOL?
Yes
No
11
Country
USA
Winter 20___
Summer 20___
9
ARE YOU CURRENTLY
STUDYING AT A U.S.
INSTITUTION OR COLLEGE?
Postal Code
11355
Country
Postal Code
Liberal Arts and Sciences
PROGRAM
OF STUDY
Yes
No
L1
DO YOU CURRENTLY
HOLD F-1 STATUS?
12
Yes
No
TO BE COMPLETED BY APPLICANTS ALREADY IN THE U.S.
If you are currently in the U.S., please indicate your immigration status. Attach a copy of the passport pages
with the passport number, expiration date of passport, and the U.S. visa stamp. Include copies of both sides of
Form I-94 for yourself and accompanying family members.
13
14
F-1 STUDENT STATUS
Yes
No
CURRENTLY
IN STATUS
Yes
UNIVERSITY THAT ISSUED
MOST RECENT FORM I-20
15
CURRENT
U.S. SCHOOL
16
OTHER IMMIGRATION STATUS
(IF APPLICABLE, SPECIFY TYPE
17
I-94 ADMISSION
NO.
Name
(Attach copies of ALL your
previously issues I-20forms)
No
SEVIS #
Address: Number and Street
I-94 EXPIRES ON
City
State
ZIP Code
Month/Day/Year
1
Declaration & Certification of Finances
Please indicate the source and amount of your financial support for the first three years of study at Queensborough Community College, for the
college requires documentation of guaranteed support for the first year and projected support for future years. Note that costs may rise every
semester. Total amounts must meet or exceed the estimate of expenses (see “Sponsor Supporting Evidence” page).
U.S. immigration authorities require colleges to receive satisfactory financial certifications from prospective students before issuing a Form I-20.
Therefore, you must attach a copy of the original documents for each source of financial support you indicate. Please refer to the “Sponsor
Supporting Evidence” page for a list of acceptable supporting documents. Be sure to have an additional set of original documents for your
appointment at the U.S. Consulate (or Embassy) overseas.
Complete and send in this page with your application. Provide as much detail as possible. Please type or print clearly with a pen.
SOURCES OF FINANCIAL SUPPORT (Amount in U.S. Dollars)
A
Guaranteed
Support Yr.1
Projected
Support Yr.2
Projected
Support Yr.3
$
$
$
$
$
$
$ 34,239
$ 34,239
$ 34,239
$
$
$
$
$
$
$
$
$
$ 34,239
$ 34,239
$ 34,239
STUDENT (if Self-Sponsor)
Name (as in passport)
The student must provide the following document in English: a bank officer’s summary
statement of account history signed and stamped by bank officer.
Name of bank (if self-sponsor)
B
Location
City
Country
NAME OF SPOUSE AND CHILDREN ACCOMPANYING/FOLLOWING TO JOIN PERSON
Spouse (as in passport)
Sex
Age
Child (as in passport)
Sex
Age
Child (as in passport)
Sex
Age
Child (as in passport)
Sex
Age
PARENTS, AND/OR OTHER INDIVIDUAL SPONSORS
C
John Doe
Uncle
Name
Relationship to Student
Name
Relationship to Student
GOVERNMENT, UNIVERSITY, OR OTHER SPONSOR
D
Source
Source
(Attach current signed official copy of the terms of sponsorship, including amount of support in
U.S. dollars and period covered.
GRAND TOTALS
THE COLLEGE CANNOT ISSUE A FORM I-20 UNTIL YOU MEET ALL REQUIREMENTS FOR FINANCIAL DOCUMENTATION.
By signing my name to this form, I certify that the information above is a correct statement of my arrangements for financing my studies
Queensborough Community College of The City University of New York.
John Smith
Student’s Signature
John Smith
06/01/2015
Date : (Month/Day/Year)
Student’s Name (Print)
2
AFFIDAVIT OF SUPPORT
This form is for individuals using their own income and/or savings to support a student. It must be completed by
the person who will provide the student with full or partial financial support and/or room and board during the
student’s course of study at Queensborough Community College of The City University of New York.
SPONSOR INFORMATION
I,
, citizen of United States of America
John Doe
(Name of sponsor)
,
(Country/ies)
1
and residing at 123 Main Street
(Street)
I am employed with
Flushing, NY
USA
11355
718-555-6666
(City/State)
(Country)
(Postal Code)
(Telephone)
Queensborough Community College, City University of New York
(Name of employer)
located at 222-05 56th Avenue Bayside, NY USA
(Street)
11364 718-631-6666
(City/State) (Country)
(Postal Code)
(Telephone)
I receive an annual income of $ __93,990_______(U.S.) from this employment. Attach verification of annual income
(e.g., paystubs, record of regular bank deposits). The verification of annual income must be written in English or
come with a certified translation.
I have $ 40,000
3
(U.S.) on deposit with
Name of Bank: Commerce Bank
Address of Bank: 1000 Walnut
Kansas City
(Number and Street)
4a
I currently support
1
My total annual expenses are $
4b
I sponsor
0
MO
(City)
(State)
persons (including myself). My total annual income is $
30,000
64106
(Postal Code)
93,990
(U.S.).
(U.S.).
(number) individuals for immigration in addition to this affidavit.
STUDENT SUPPORT INFORMATION
This affidavit is executed on behalf of John Smith
5
who was born on
(Name of Student)
01/01/1990
. S/he is my
(Month/ Day /Year)
Nephew
(Relationship to Sponsor)
I hereby certify that I am willing, able, and do commit to provide John Smith
with the annual amount of
(Name of Student)
6
$ 34, 239
(U.S.) for her/his tuition, fees, and/or living expenses each year during the entire program of study
at Queensborough Community College CUNY until
06/30/2018
(give a date when the sponsorship is
expected to terminate).
ROOM AND BOARD SUPPORT INFORMATION (To be completed if student will live in the sponsor’s home in the U.S.).
I hereby certify that I will provide John Smith
with (check one):
(Name of Student)
7
Room only in my home at the address indicated above (valued at $13,848) OR
Full room and board in my home as indicated above (valued at $16,695) during each year that s/he follows a
program of study at Queensborough Community College CUNY.
SIGNATURE
By signing my name to this affidavit, I certify that the information above is a correct statement of my agreement to
sponsor the student herein named.
Signature of sponsor John Doe
06/01/2015
Month/Day/Year
Name of Sponsor (Print)
John Doe
3
SPONSOR SUPPORTING EVIDENCE
In addition to the attached Affidavit of Support, the sponsor must submit evidence of income and resources, as
appropriate:
Bank statement that includes the following information:
A
1. Account holder’s name and account number
2. Transaction history for the past three months
3. Present balance
Sponsor Employment verification:
B
1. Last three months of paystubs (pay voucher)
2. Last three months of bank account transaction history showing regular deposits
Additional documents required (if applicable):
C
1. Copy of last income tax return filed (if required in your country)
2. Commercial license or registration (if self-employed)
Sponsor in the United States must provide one of the following:
D
1. U.S. Passport
2. U.S. Certificate of Naturalization
3. Permanent Resident Card
Estimate of 2015-16 Expenses for International Students Attending the City University of New York
Tuition and fees per academic year (12 months)…………………………………..…….$7,680.00*
Student Living Expenses
Books and supplies……………………………………………………………………….....$1,364.00
Transportation……………………………………………………………………...…….….$1,360.00
Personal Expenses…………………………………………………………………………...$5,610.00
Housing……………………………………………………………………………….........$13,848.00
Meals (at home)………………………………………………………………………............$2,847.00
Lunch…………………………………………...…………………………………………….$1,530.00
Total Student Living Expenses……………………………………………..………….....$26,559.00
____________________________________________________________________________
Total Annual Expenses…………………………………………….……………………$34,239
*Tuition and fees are based on a student attending full time every term at Queensborough Community
College. Tuition and fees may rise every semester. Student must attend the full-time academic program in
order to maintain lawful immigration status.
4
Queensborough Community College
City University of New York
222-05 56th Avenue
Bayside, NY 11364
Earnings Statement
Deductions Year to Date
Employee
Number
Employee Name
Period Beginning Period Ending
6/1/2015
John Doe
123456
Description
Rate
Hours
Earnings
Regular Earnings
$51/hr
70
$3,615.08
Gross Earnings
$3,615.08
6/14/2015
Check Date
6/15/2015
Federal Tax
$280.00
$3,640.00
State Tax
$87.00
$1,131.00
SS Tax
$40.00
$520.00
Queensborough Community College
City University of New York
222-05 56th Avenue
Bayside, NY 11364
Earnings Statement
Deductions Year to Date
Employee
Number
Employee Name
John Doe
123456
Description
Regular Earnings
Gross Earnings
Rate
$51/hr
Hours
70
Period Beginning Period Ending
5/17/2015
Earnings
$3,615.08
$3,615.08
5/31/2015
Check Date
6/1/2015
Federal Tax
State Tax
SS Tax
$280.00
$87.00
$40.00
$3,640.00
$1,131.00
$520.00
Queensborough Community College
City University of New York
222-05 56th Avenue
Bayside, NY 11364
Earnings Statement
Deductions Year to Date
Employee
Number
Employee Name
John Doe
123456
Description
Regular Earnings
Gross Earnings
Rate
$51/hr
Hours
70
Period Beginning Period Ending
5/3/2015
Earnings
$3,615.08
$3,615.08
5/17/2015
Check Date
Federal Tax
$280.00
$3,640.00
State Tax
SS Tax
$87.00
$40.00
$1,131.00
$520.00
5/18/2015
Queensborough Community College
City University of New York
222-05 56th Avenue
Bayside, NY 11364
Earnings Statement
Deductions Year to Date
Employee
Number
Employee Name
John Doe
123456
Description
Regular Earnings
Gross Earnings
Rate
$51/hr
Hours
70
Period Beginning Period Ending
4/19/2015
Earnings
$3,615.08
$3,615.08
5/3/2015
Check Date
Federal Tax
$280.00
$3,640.00
State Tax
SS Tax
$87.00
$40.00
$1,131.00
$520.00
5/4/2015
Queensborough Community College
City University of New York
222-05 56th Avenue
Bayside, NY 11364
Earnings Statement
Deductions Year to Date
Employee
Number
Employee Name
John Doe
123456
Description
Regular Earnings
Gross Earnings
Rate
$51/hr
Hours
70
Period Beginning Period Ending
4/5/2015
Earnings
$3,615.08
$3,615.08
4/19/2015
Check Date
Federal Tax
$280.00
$3,640.00
State Tax
SS Tax
$87.00
$40.00
$1,131.00
$520.00
4/20/2015
Queensborough Community College
City University of New York
222-05 56th Avenue
Bayside, NY 11364
Earnings Statement
Deductions Year to Date
Employee
Number
Employee Name
John Doe
123456
Description
Regular Earnings
Gross Earnings
Rate
$51/hr
Hours
70
Period Beginning Period Ending
6/1/2015
Earnings
$3,615.08
$3,615.08
4/5/2015
Check Date
Federal Tax
$280.00
$3,640.00
State Tax
SS Tax
$87.00
$40.00
$1,131.00
$520.00
4/6/2015
Queensborough Community College
City University of New York
222-05 56th Avenue
Bayside, NY 11364
Earnings Statement
Deductions Year to Date
Employee
Number
Employee Name
John Doe
123456
Description
Regular Earnings
Gross Earnings
Rate
$51/hr
Hours
70
Period Beginning Period Ending
3/7/2015
Earnings
$3,615.08
$3,615.08
3/21/2015
Check Date
Federal Tax
$280.00
$3,640.00
State Tax
SS Tax
$87.00
$40.00
$1,131.00
$520.00
3/22/2015