F-1 New Student Check In Form - Northern Virginia Community College
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2Form 125-045
Rev. 4/10
Page 1 of 2
F-1 New Student Check In Form
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DATE: ______________________
NAME: _________________________________________________________________
(Family/Last Name)
(First/Given Name)
STUDENT ID: _______________________
BIRTHDATE: _______/______/_________
(month / day / year)
SEVIS NUMBER: N____________________ CAMPUS:__________________________
ADDRESS IN U.S.:
House #: _____________
Street:
Apt. #: _______________
City:
State:
____________
Zip Code: ______________________
PHONE (HOME): __________________________________
PHONE (CELL): ___________________________________
E-MAIL ADDRESS: ___________________________@________________________
EMERGENCY CONTACT NAME: __________________________________________
PHONE:
(HOME): _________________________
(WORK): _________________________
STUDENT’S SIGNATURE: _______________________________________________
For office use only:
Documents presented:
Passport _____
Visa ______
I-20 _____
I-94 _____
WA2 Removed _________
Staff Name _______________________
Date ________
F-1 Removed __________ Staff Name ____________________
Date ________
SEVIS Registration
Staff Name ____________________
Date ________
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Parent category: Business