SEVIS Enrollment Form

Doane College SEVIS Enrollment  Information - Crete Campus

Last Name:_________________________  First Name:______________________  Date:_________

• I understand that I must inform INS/Doane College regarding any change in my home, telephone, or contact information.
• I understand that the length of my program is 4 years, that I am required to complete a minimum of 12 credit hours per semester.  I understand that I have provided documentation to demonstrate the proof of my financial responsibility, and while I am enrolled at Doane College I will not work on- or off-campus.  
• I understand I must contact the Doane College SEVIS Compliance Office (402.826.8215) 30 days before I plan to travel outside the U.S. in order to obtain the proper travel documents.
• I understand that I must contact the Doane College SEVIS Compliance Officer (402.826.8215) prior to withdrawal of class(es), prior to completion of coursework, prior to graduation, and/or prior to transfer to another school.  
• I understand that I must provide proof of insurance before enrolling each term.
• I understand that within 60 days after the completion of my degree at Doane College,  I must leave the U.S. or have an I-20 from a new school, or I will be "out -of-status" with the INS. 
• I know I cannot leave the U.S. and come back into the U.S. without special papers.
• I understand that if I withdraw from the Doane College undergraduate program before the completion of my studies I must contact the SEVIS compliance officer immediately to complete exit paper work.

______________________________________________________________
Student's Signature                                Date

ABOUT YOU:

First Name:______________________________
Last Name: ______________________________
Middle Name:_____________________________

Name on Passport:_____________________________________________Gender: ___M  ___F

Visa Type:_______  Visa Expires:___________  Admission # (on I-94 card):_____________________

Port of Entry:____________ Tax ID #____________________Social Security #:__________________

Drivers License # :____________________  State:__________________ Expires:________________

Date of Birth:_______ (mm/dd/year)  Country of Birth:__________________Citizenship:______________

Current U.S. Home address:____________________________________________________________
(CANNOT be a P.O. Office Box)

                                       _____________________________________________________________

Phone:____________________

E-mail:____________________________  Cell Phone:_____________________ Pager:___________

US Emergency Contact Name: ______________________________________Phone:______________

Address: ___________________________________________________________________________

Current Residential Foreign Address:____________________________________________________

                                                  ______________________________________________________

Phone:_______________________

Home Country Emergency Contact  Name and Address:______________________________________

__________________________________________________________________________________________

Home Phone:_________________________    Cell Phone:___________________________________

PROGRAM INFORMATION:

Current Program: __ Undergrad Crete  __ MAC  __ MAM __ MED

Expected Graduation Date: _______________________

Major 1:____________________________________

Major 2:____________________________________

Current Minor:_______________________________

Do you plan to apply for Optional Practical Training?  __ no  ___ yes--when?____________________

DEPENDENT INFORMATION:

Do you have any dependents?  ___ no ___ yes-where are they living? _________________________

Name:_______________________ DOB_______ Citizenship_______________Relationship________

Name:_______________________ DOB_______ Citizenship_______________Relationship________

Name:_______________________ DOB_______ Citizenship_______________Relationship________

Name:_______________________ DOB_______ Citizenship_______________Relationship________

Name:_______________________ DOB_______ Citizenship_______________Relationship________

Name:_______________________ DOB_______ Citizenship_______________Relationship________

Name:_______________________ DOB_______ Citizenship_______________Relationship________

SCO:

___copy to student __copy to student INS file __copy to Doane student File   __ Copy to SEVIS file