Form 1-17 - Petition For Approval Of School For Attendance By Nonimmigrant Student Page 8
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11OMB No. 1115-0070
U.S. Department of Justice
Record of Designated School Officials
Immigration and Naturalization Service
Instructions
Form I-17, Supplement A, listing up to five designated school officials for each school or campus within a school system (except
(1)
an elementary or secondary school system as noted below), must be attached to each Form I-17, Petition for Approval of School for
Admittance by Nonimmigrant Students. If there is a change in designated school officials, a new Supplement A must be completed
and submitted within 30 days to the Immigration and Naturalization Service (INS) office having jurisdiction over the school.
(2) "Designated School Official" (DSO), as defined in 8 CFR 214.3, means a regularly employed member of the school administration
whose office is located at the school and whose compensation does not come from commissions for recruitment of foreign students.
A DSO may not delegate this designation to any other person. An individual whose principal obligation to the school is to recruit
foreign students for compensation may not be a DSO. The DSO is required to have a thorough knowledge of the regulations, policies
and procedures governing nonimmigrant students.
Each school or institution may have up to five DSOs at any one time. In an elementary or secondary school system, however, the
entire school system is limited to a total of five designated officials at any one time.
DSO Intention to Comply With Pertinent INS Student/School Regulations
I, THE UNDERSIGNED, have read the Immigration and Naturalization Service's regulations relating to nonimmigrant students, namely
8 CFR 214.1, 8 CFR 214.2(f) and/or 8 CFR 214.2(m); the INS regulations relating to change of nonimmigrant classification for students,
namely 8 CFR 248; the INS regulations relating to school approval and withdrawal of school approval, namely 8 CFR 214.3 and 214.4,
and intend to comply with these regulations at all times.
Signature
(Print or Type)
Telephone number
Designated Official:
Title
Last and First Name:
Initial designation
Correction to previous designation
Replacement for prior designated official
Designated Official:
Title
(Print or Type)
Signature
Telephone number
Last and First Name
Correction to previous designation
Initial designation
Replacement for prior designated official
(Print or Type)
Title
Signature
Telephone number
Designated Official:
Last and First Name
Initial designation
Replacement for prior designated official
Correction to previous designation
Designated Official:
(Print or Type)
Signature
Telephone number
Title
Last and First Name
Initial designation
Replacement for prior designated official
Correction to previous designation
Signature
(Print or Type)
Designated Official:
Title
Telephone number
Last and First Name
Replacement for prior designated official
Initial designation
Correction to previous designation
Continued on next page
Form I-17 (Rev. 04/05/02) Supplement A Page 1
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