Form I-17 Petition for Approval of School for Attendance by Nonimm

OMB No. 1653-0038 Expires 3/31/2018

Petition for Approval of School for
Attendance by Nonimmigrant Student

Department of Homeland Security
U.S. Immigration and Customs Enforcement

START HERE – Please read instructions before beginning. Type or print in black or dark blue
ink.
THIS SECTION IS TO BE COMPLETED BY THE SCHOOL. If more space is needed to
Fully answer any items on this form, use a separate sheet(s). Identify each answer with the letter
and number of the corresponding item and sign and date each sheet. Indicate that an item is not
applicable with “N/A”. If the answer is “none,” please write “none.” This application must be filed
with the required evidence as noted below, be properly signed and submitted with the correct fee.

To U.S. Immigration and Customs Enforcement:
1. Petition is made for approval, or continuation of approval, of this institution as a school for
attendance by nonimmigrant alien students under (complete as appropriate):
Section 101(a)(15)(F) of the Act (academic and language students)
Section 101(a)(15)(M) of the Act (vocational students)
Both of the above sections of the Act
2. Name of school

FOR ICE USE ONLY
School Code __ __ __ 214F __ __ __ __
Approval for attendance of students under:
Section 101(a)(15)(F) of the Act.
Section 101(a)(15)(M) of the Act.
Both of the above sections of the Act.
This request is to:
Create a file.
Update a file.
Fee Stamp

Action Stamp

3. Mailing address of school
4. This school is a:
Remarks:
Publicly owned institution (Leave No. 10 blank).
Private institution (Complete No. 10).
5. This school is engaged in: (check appropriate blocks and explain further if necessary)
Elementary education including lower, middle and junior high schools
High school education (academic or vocational)
Vocational or technical education (other than high school)
Language training
Higher education (issuing one or more of the following recognized degrees: Bachelor’s, Associate’s, Master’s, Ph.D.).
Other (explain)
6. This school’s sessions are based on
Semesters
Trimesters
Quarters
Other (explain)
7. Provide the date and month registration begins for EACH session during a calendar year, including the summer session, if your school has one.
a.
d.
g.
j.
b.
e.
h.
k.
c.
f.
i.
l.
If there is no beginning registration date, pleased explain:
8. Date school was established 9. Location of school (if different from mailing address)
10. Name, address and telephone of owner
(i.e., enrolled first class of
students)
11. Petition is for:
Initial approval

Continuation of approval. Please complete the following:

12. The school operates under the following state, local, or other license or
approval (if none, write “none”):

Received

Ret’d-Trans.Out Trans.

Date of original approval
ICE school code
13. The school has been approved by the following nationally
recognized accrediting association or agency (if none, write “none”):

In

Completed

Continued on next page
Form I-17 (Rev. 10/31/07) Y

OMB No. 1653-0038 Expires 3/31/2018

Petition for Approval of School for
Attendance by Nonimmigrant Student

Department of Homeland Security
U.S. Immigration and Customs Enforcement
14. Nature of subject matter taught (check as many as are appropriate):

Liberal Arts (i.e., those fields of study of general cultural concern such as philosophy or history and, in some cases, theology).
Fine Arts (i.e., those that exist chiefly for beauty, such as sculpture and painting, as opposed to utility).
Professional Studies (e.g., architecture, engineering, law, medicine, and education).
Religious
Language
Vocational or Technical Training (i.e., training relating to a trade, technique, or mechanical or industrial skill).
Other (explain)
15. List the degrees available from the school

16. Check as appropriate and explain further if necessary:
If the school is engaged in elementary or secondary education it:
accredited schools of higher educational level.
If the school is engaged in higher education, it:
divinity schools.
Its degrees

are

are not

does

does not qualify its graduates for acceptance by

does not confer recognized bachelor’s, master’s, doctor’s professional or

transferable to institutions of study that confer such degrees.

If the school is engaged in vocational or technical education, it
17. Sessions are held as follows:

does

Day only

does
Night Only

does not qualify its graduates for employment.
Day and Night

18. Requirements for admission:

19. Courses of study and time necessary to complete each course:

20. Requirements for graduation:

21. Causes for expulsion:

22. Average annual number of:
Classes

Students

Teachers or instructors

23. Approximate annual total cost of room, board, tuition, etc., per student

Non-teaching employees

$

Continued on next page.
Form I-17 (Rev. 10/31/07) Y

OMB No. 1653-0038 Expires 3/31/2018

Petition for Approval of School for
Attendance by Nonimmigrant Student

Department of Homeland Security
U.S. Immigration and Customs Enforcement

Execution of Petition
If the school is approved, The Petitioner Agrees:
1. Upon acceptance of any nonimmigrant alien student, to furnish that student a Certificate of Eligibility, Form I-20 A/B for an F-1
student, or Form I-20 M/N for an M-1 student.
2. To keep records containing the following specific information and documents relating to each nonimmigrant F-1 or M-1 student to
whom the school issues a Form I-20 A/B or I-20 M/N, while the student is attending the school and until the school notifies ICE in
accordance with regulations at 8 CFR 214.3, that the student is no longer pursuing a full course of study. The school must keep a
record of having complied with the reporting requirements for at least one year. If a student out of status is restored to status, the
school that enrolled the student must maintain these records following receipt of notification from ICE that the student’s status has
been restored. The school must keep and, upon request, make available to ICE, the following information and documents for each
nonimmigrant F-1 and/or M-1 student.
a.
b.
c.
d.
e.
f.
g.
h.

Name
Date and place of birth
Country of citizenship
Address
Status, i.e., full-time or part-time
Date of commencement of studies
Degree program and field of study
Whether the student has been certified for practical training and the beginning and
ending dates of certification
Termination date and reason, if known
Documents referred to in paragraph 212.3(k) regarding the Certificate of Eligibility
Number of credits completed each semester
Photocopy of the student’s I-20 ID Copy

i.
j.
k.
l.

3. That in any advertisement, catalogue, brochure, literature, or other material produced by or for this school, any statement that may
appear concerning approval for admittance by nonimmigrant students much be limited to the following: “This school is authorized
under Federal law to enroll nonimmigrant students.”
I certify that I am authorized to execute this petition. I understand that unless this institution fully complies with all terms as described
on this form, approval may be withdrawn pursuant to 8 CFR 214.4.
Dated at:

, this

day of

,

Signature:
Name and Title:

(CORPORATE SEAL OF INSTITUTION)

Form I-17 (Rev. 10/31/07) Y

OMB No. 1653-0038 Expires 3/31/2018

Department of Homeland Security
U.S. Immigration and Customs Enforcement

Record of Designated School Officials

Instructions
(1) Form I-17, Supplement A, listing up to five designated school officials for each school or campus within a school system (except 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 with 30 days
to the U.S. Immigration and Customs Enforcement.
(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 ICE Student/School Regulations
I, THE UNDERSIGNED, have read the U.S. Immigration and Customs Enforcement regulations relating to nonimmigrant students, namely 8 CFR
214.1, 8 CFR 214.2(f) and/or 8CFR 214.2(m); the U.S. Immigration and Customs Enforcement regulations relating to change of nonimmigrant
classification for students, namely 8 CFR 284.1 (c)(d) ; the U.S. Immigration and Customs Enforcement 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.

Designated Official (Print or Type)
Last and First Name
Initial Designation

Title

Signature

Replacement for prior designated official

Telephone
Correction to previous designation

Designated Official (Print or Type)
Last and First Name
Initial Designation

Title

Signature

Replacement for prior designated official

Telephone
Correction to previous designation

Designated Official (Print or Type)
Last and First Name
Initial Designation

Title

Signature

Replacement for prior designated official

Telephone
Correction to previous designation

Designated Official (Print or Type)
Last and First Name
Initial Designation

Title

Signature

Replacement for prior designated official

Telephone
Correction to previous designation

Designated Official (Print or Type)
Last and First Name
Initial Designation

Title

Signature

Replacement for prior designated official

Telephone
Correction to previous designation

Continued on next page.

Form I-17 (Rev. 10/31/07) Y

OMB No. 1653-0038 Expires 3/31/2018

Department of Homeland Security

Record of Designated School Officials

U.S. Immigration and Customs Enforcement

Certification 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)

Name of school system, school or campus (list all schools or
campuses and their three-digit suffixes for which the above
officials are designated, if for more than one school or campus,
but not for the entire school system).

ICE File No., if known:

Signature

214F

Date:

(If this is a multi-campus institution or school system, use the 3digit suffix for the main or initial campus.)

Address of school system, school, or campus:

Form I-17 (Rev. 10/31/07) Y

Department of Homeland Security
U.S. Immigration and Customs Enforcement

OMB No. 1653-0038 Expires 3/31/2018

Record of School(s)/Campus(es)

Instructions
Form I-17 Supplement B must be completed and submitted with Form I-17 if a school system of multi-campus institution is seeking
approval for a number of schools for admittance by nonimmigrant students. Furnish all know information for each school or campus
within the system. If more space is needed to list all schools, attach additional forms as necessary, and number each at the bottom. If
an approved school system seeks to update or correct the information on its original Supplement B, a new Form I-17 must be
submitted, without fee, accompanied by Supplement B, and if applicable, Supplement A. Please PRINT or TYPE all information on
this form.

Requested
Initial approval for the following school(s) or
Addition of the following school(s) or campus(es) to the list of approved institutions within the above school system
Removal of the following school(s) or campus(es) from the list of approved institutions within the above school system
Change or correction in the following information relating to school(s) or campus(es) that have been approved.
Fill in only the information that is to be added to or adjusted in the ICE records and the school’s three-digit suffix.
1. School or Campus Name

2. School or Campus Three-Digit Suffix

3. Mailing Address (include Zip Code)

4. Location (if different from mailing address)

1. School or Campus Name

2. School or Campus Three-Digit Suffix

3. Mailing Address (include Zip Code)

4. Location (if different from mailing address)

1. School or Campus Name

2. School or Campus Three-Digit Suffix

3. Mailing Address (include Zip Code)

4. Location (if different from mailing address)

1. School or Campus Name

2. School or Campus Three-Digit Suffix

3. Mailing Address (include Zip Code)

4. Location (if different from mailing address)

Form I-17 (Rev. 10/31/07) Y