Uscis Form I-94 - Arrival/departure Record (With Instructions) Page 2

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Primary Inspection
Applicant's
Name
Date
Referred
Time
Insp. #
Reason Referred
PP
Visa
TWOV
212A
Parole
SLB
Other
Secondary Inspection
End Secondary
Time
Insp. #
Disposition
18. Occupation
19. Waivers
20. INS File
21. INS FCO
A-
22. Petition Number
23. Program Number
Bond
25.
Prospective Student
24.
26. Itinerary/Comments
27. TWOV Ticket Number
Warning -
A nonimmigrant who accepts unauthorized employment is subject to
deportation.
Important -
Retain this permit in your possession; you must surrender it when you
leave the U.S. Failure to do so may delay your entry into the U.S. in the future.
You are authorized to stay in the U.S. only until the date written on this form. To
remain past this date, without permission from immigration authorities, is a violation
of the law.
Surrender this permit when you leave the U.S.
- By sea or air, to the transportation line;
- Across the Canadian border, to a Canadian Official;
- Across the Mexican border, to a U.S. Official.
Students planning to reenter the U.S. within 30 days to return to the same school, see
"Arrival-Departure" on page 2 of Form 1-20 prior to surrendering this permit.
Record of Change
Port:
Departure Record
Date:
Carrier:
Flight # / Ship Name:

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