Form 1-17 - Petition For Approval Of School For Attendance By Nonimmigrant Student Page 9
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11Certification By President, Owner or Head of School or School System
I, the undersigned president, owner or head of the school or school system named below certify that the above individuals are
designated school officials of the school or school system. Further, I certify that I will be responsible for providing the resources and
training necessary for these officials to properly implement the above referenced regulations.
Name (Print or Type)
Title (Print or Type)
Signature
Date:
Name of school system, school or campus (list all schools or
214F
INS FILE No., if known:
campuses and their three-digit suffixes for which the above
(If this is a multi-campus institution or school system,
officials are designated, if for more than one school or campus,
use the 3-digit suffix for the main or initial campus.)
but not for the entire school system).
Address of school system, school or campus:
Form I-17 (Rev. 04/05/02)Y Supplement A Page 2
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