ELS Language Centers ENROLLMENT CONFIRMATION Central Admissions Department | Phone: +1 609.759.5900 | Pax: +1 609.524.9880 | ad missions@els.edu ll ENRIO: To: Mr. CESAR REBOLLAR —SREMEX | 09-OCT-2015 GALVAN From: P royectacm cesarrebollart 1 @gmail.com. proyectacm@els.edu proyectat00milcte@sre.gob.mx We are pleased to confirm that we have received and processed the fllowing student's enrolment, Please take a moment to carefully review the details isted below and adviso us immediately if any corrections or changes are needed Personal Information bianeniunad 2eaaieg Family Name: REBOLLAR GALVAN Country OF Birth Mexico First Name: CESAR Country Of Citizenship: Mexico Middle Name: 1-20 Requestes: Yes Date of Bith 04-DEC-1983 Gender Male Program Information Conter Grand Rapids (GRR) Program: English for Academic Purposes Session Date: 19/16/2015 Enrollment Status Applicd Program Start date: 11/16/2018 Promolb: G15SREMEX Total weeks: 4 Accommodation Information Housing Type: Homestay (Check-in Date 18-Nov-2015 Homestays in the area Check-out Date: 12-0EC-2015 Room Type! Singles Early Arival Requested Reservation Status Confirmed (Other Special Requests: None + Homestay placement details wll be faxed 20 days pror to program start date Other Services Mall Service: DHLF ‘Airport Piek Up: Requested StudentHealth Plan: Yes + Airport Pick-up service requested. Flight details must be received at lesst one week prior to the scheduled start dat.Department of Homeland Security 1.20, Certificate of Eligibility for Nonimmigrant Student Status USS, Immigration and Customs Enforcement OMB NO, 1653-0038 SEVIS ID: NO015304324 [SURNAMEIPRIMARY NAME GIVENNAME, CLASS InesouLaR cava CEEAR [PREFERRED NAME PASSPORT NAME (counTRY OF BIRTH COUNTRY OF CITIZENSHIP = bate or sett ADMISSION NUMBER lo¢ vecenben 1983 ACADEMIC AND 'FORM ISSUE REASON LEGACY NAME LANGUAGE SCHOOL INFORMATION [scHooL NAME SCHOOL ADDRESS [ELS Language Centers/Grand Rapids C/o Grend Valley State University, Allendale,¥t 49401 ELS Language Centere/Grand Rapids Scuoot ‘SCHOOL CODE AND APPROVAL DATE (liver er2i4e01425000 [Scudent Services Coordinator 22, OCTOBER 2004 PROGRAM OF STUDY lEDUCATION LeveL. MAJOR MAJOR? HEANGUAGE TRAINING Second Language learning 32.0209 None 00.0000 NORMAL PROGRAM LeNGri, PROGRAM ENGLISH PROFICIENCY ENGLISH PROFICIENCY NOTES 13 months Not Reavired English inatruction will be given at [PROGRAM START DATE. PROGRAM END DATE he NoveNbER 2015 09 DECEMBER 2016 INANCIALS [ESTIMATED AVERAGE COSTS FOR: | MONTHS ‘STUDENT'S FUNDING FOR: | MONTHS Inoition and Fees 3 1,790 Personal Funds & 3,320 Living Expenses 3980 Funds From This School $ lexpenses of Dependents (0) 5 ° Funds Fron Another Source 5 lusse 3550 On-Campus Employment 5 TOTAL 3.320 TOTAL 33,320 EMARKS gran length ie 4-56 weeks dependent upon placement level, 2 unable co enter 0.8, by 11/16/2015, student Jaiso eligivie to begin classes on 12/14/2015. The Center Director ia Nicholas Ghigiia, (616) 331-5222. SCHOOL ATTESTATION [erty under pealty of peur tht ll formation provided wbove was entered before [signed thi orm ad iy wus and cones | executed ths frm in the Ualed utes ate review and evasion inthe United State by me or other oficial af the school the stents uplicaion, vanseips, ot ote ecards of eouses akon lind prot of rani responniblty, wich was received te school prior to the exciton of his form, The chao as determined tha he above ane students Ivalicstons mest ll sandd the seliool gps student wil be eguired to pursue fl rogram of sud us defines by 8 CER 214.2006) lame» lesgnted sn00 officiel ue this fore, DATE ISSUED. PLACE ISSUED NATURE OF: 01 STUDENT ATTESTATION {have read and ugred to comply withthe tar nd condi of my alan and thon of way extension of way. cerita al infomation provided on hia form fefr spill to mean igre and core tothe best of my knowledge 1 ceri at I sue to ener or serain in che United States temporal, an solely forthe purpose of pursing u fl program af tay tthe schol nerd above zo whore the named school to releae ay information fom my pursuant 8 CFR 214.3) fo datarmine my nonimmigrant sate Parent or guardian, and dent, must sign student is under 18, rds needed by DHS x. [SIGNATURE OF: CESAR REBOLLAR GALVAN DATE x [NAME OF PARENTORGUARDIAN SIGNATURE ADDRESS (clita or province DATE ICE Form 1-20 (3/31/2018) Page lof 3Department of Homeland Security 1.20, Certificate of Eligibility for Nonimmigrant Student Status USS, Immigration and Customs Enforcement (OMB NO, 1653-0038 SEVIS ID: NO015304324 (F-1) NAME: CESAR REBOLLAR GALVAN EMPLOYMENT AUTHORIZATION [eMPLOYMENTSTATUS TYPE [eMPLOYMENTSTART DATE EMPLOYMENT END DATE. IeMPLOYER NAME, EMPLOYER LOCATION comments CHANGE OF STATUS/CAP-GAP EXTENSION (WQUESTHD VISATYPE—_ RBQUUSTIPETITION STATUS RECEIPT NUMBER BENET START ONTERUQUEST DATE EVENT HISTORY (erase DENTDATE ] OTHER AUTHORIZATIONS [aoTHoRzariOw STARTDATE TROBE | ‘TRAVEL ENDORSEMENT This page when propery endoned, may be was for reniry of he sade i lend he are school alr a temporary absece fom the Uniied Ss, Bach eetetion sigma vald fr ore you, [SCHOOL OFFICIAL, TITLE, SIGNATURE, DATE ISSUED PLACE ISSUED x x ICE Form 1-20 (3/31/2018) Page 20f 3Department of Homeland Security US. Immigration and Customs Enforcement 1.20, Centficate of Eligibility for Nonimmigrant Student Status OMB NO, 1653-0038 INSTRUCTIONS TO STUDENTS STUDENT ATTESTATION, You should read everything on this puge ‘arly. Be sue tat you understand the tems snd eneionseonceing yo Simision ad yin the United Sates nonnmigan stdent before sighing the student atestation on pege I of the Rorm 1-20; The nw provides sever rales for knowingly und wilfully falsifying or concealing s mati fct, ot ‘sing any fale dacuben isthe ubtiasion ofthis fom. FORM 1-20. The For 1-20 (this form) isthe primary documento show ta you have bees admitted to school in tho Unitod States and thu you are {sthozed to apply for acini tothe United Stes nF clas of ub, You rust haveyour For -20 wit ou sul tas, Hy lose your Fors -20, you must request anew one fom you designated school Miia! (DSO) at he Stet rane on yous Form 20. VISA APPLICATION, You must give this Form 1-20 0 the US. consulur officer at the time you spply for a visa (unless you are exempt from Vis ‘euiremen) fy haved Frm £20 frm more than ane schoo, be sue © [present the Form 120 fer the sehool you plan to tend, Your via ll nla ‘he name of tat schoo}, and you must send tht school upon eneriog he United States, You mist also provide evidence of support for tition ana fees and ving expenses while you arene Und Sats, ADMISSION. When you enter the United Siaies, you muse present che following documents tothe ofier atthe pos oF enuy: 1) Frm 20; 2) 4 valid Ft iss (unless you are exemp rom vst reguiremerts, 3) vali passport nd 4) evidence of suppor fo tition and fes an living expense whe you it tne United Stns. The wgent shold reall documents to 0 before You eave He inapetion ae REPORT TO SCHOOL NAMED ON YOUR FORM I-20 AND VISA. Upon your fist ety tote United Suites, you must report ro the DSO atthe scheck. aed on yout Fors 120 and your Fl visa (unless you ae exempt for Vist {quirements Ifyou decide to tend unoter hol before yo ener the United Stes, you must preset a Ferm 1-20 ffom the new school to a US. consular tier fora new f= visa that rams the new sehoo. Fale io eral in School, by the program sur date on your Fora 1-20 iy raul in he loss of yoursiodent satus and subject you fo deportation EMPLOYMENT. Unlawfbl employment inthe United Stis isu reason for {exminaing your Fl stats and cepotng you from the United States. You may ‘be employed on campus at your seheo. You may be employed off-campus in curiula pratial tising (CPT) iP you have writen permision from your DSO. Youmay wply to US. Citizenship and Immigration Services (USCIS) for offeumpus employment authorization n three eirumstanes: 1) employment ‘with en reratloal organization 2) severe und unexpecte econo hardship: 43) opal ctl ning (OP) rtd your dpe, You ma ave utorzon om USCIS before you begin Work, Contact You DSO for “Your spouse or child (F-? classification) may ot work inthe United PERIOD OF STAY. You muy remain i the United States while aking ofall sourse of kody of dung authorized employment afer your program. F- satus fhds ahd you ae vequted to leave tke United States on the culest ofthe folowing dates 1) the program end date on yout Form 20 plus 60 day 2) te {end date of your OPT pls 60 days, oF 3) the tesminaton of you program or ty ofr reason, Conte! your DSO for deta [EXTENSION OF PROGRAM. Ifyou cannot complete the education rogram bythe program end éteon page 1 of your For 120, you should const your ‘DSO afeas 1S ays Before he progian end dat request an extension, ‘SCHOOL TRANSFER. To unser schools, frst nly the DSO a he school youarealending of your pla to transfer, then obtain a Form 20 from the DSO A the school you pl to ated, Return the For 1-20 forthe ew seal othe DSO at that shoo within 15 days afte beginning utendance athe new schol ‘The DSO wil then port the ane o the Departet of Homeland Secunty (OHS), You must ental n the ew school athe next session sut date. The ‘DSO atthe new school must update you estaton i SEVIS, ICE Form 1-20 (3/31/2018) NOTICE OF ADDRESS. When you arivs in the United States, you must report your US. addres o your DSO. IFyou move, you must nay sour DSO ryour new address within 10 day ofthe change of udress, The DSO will Update SEVIS wit your new addres, [RUENTRY, Fl students may eave the United Sutes and etm within a period Gf five months To rettn, you must have 1) «valid passport, 2) a valid F=1 ‘tudane vis (nls you af exempt fom visa requirements) and 3) your Form 1.20, page 2, property endorse for reentry by oor DSO, Ifyou have been out of ‘he United Sate for more than five mons, conti: your D30, AUTHORIZATION TO RELEASE INFORMATION BY SCHOOL. The Deparment of Homeland Security (DHS) requires your stool to provide DHS ‘wih your ame, county of it, crrent addres, mgrton sate, nd erty ‘ther infomation on rege isis or upon request You signature oa he Form 10 withaies te waned Schott lease such formation fom your rors PENALTY, To missin your sonimmigrant student tas, you mus: 1) remain ‘fulltime student at your authorized schoo: 2) engage only in authorized ‘employment, and 3) keep your passport valid. Falue to comply with these fegulaions will vesulin the loss of your student stats and subject you fo epontion INSTRUCTIONS TO SCHOOLS Failure to comply with 8 CFR 214:3() and 8 CPR 2144 when issuing Fors I= 20 wl subject you and yout schol to criminal prosecution, Ifyou sue this foo improper, provide false information, or fl subatrequired repos, DHS may witherew ils cerifieation ef your seheol Tor ullendance by oni sade ISSUANCE OF FORM 1-20. DSOs may issue « Form 1-20 for any honimngiant your sen! fs accepted fr il course of study that person 1) plan fo apply to enter the Unite Stites in Fo! stats, 2) is the United ‘Stfes san Fe nonimigrant and plano trnsfer fo you scook 3) in the Unite Sate ana il apply to change nonimmigrant satus Fl DSOs may ‘ko Isue the Fern 120 tothe spouse o chil (ander the sge of 21) of xn F-1 ‘Haden tou to ener or renin nthe United Sites aun F-2 dependent. DSOs tom sign wher nated at he bolton GF page 1 ofthe Form 1-20 to atlest at the fom i completed ad sued in accordance wih regulation. ENDORSEMENT OF PAGE 2 FOR REENTRY, If there have been no ‘substance charges in information, DSOs may endorse page 2 ofthe Frm -20 far the stident andlor the F-2 dependents to renter the United States. I there have been sbtemve changes, Cle DSO shoul issue and sigh w new Fawn 1-20 tha nls the changes, RECORDKEEPING, The Deperinent of Homeland Security (OHS) may ‘quent information ecnesring te students umigetion statis for various Feusons. DSOs sould resin ul evigense of sercemis ability and financial ‘exoires on which admision was based, unl SEVIS shows the students reser completed terminate, AUTHORITY FOR COLLECTING INFORMATION. Authority for Collecting the information on this and related student forms is contained in 8 USC. 110) and 1184, The Department of State and The Department of Homeland Security ute us informtion to determine eligi othe Benes fequestes. The aw provides severe penalties for knowingly and wilflly fulefying or conesalng + material fat, or using uny false document inthe sbmston of hs fem REPORTING BURDEN. US. tnmigetion and Customs Enforcement colles th informtion as patois agency mission ance the Deparment of Homeland Secuity The estimated average tie to review the narod, sarehexaing dat sources, pther and maintain he nesded dul, and complete and review he Salis formation 30 snes (30 hous pt espe, AN ae may net onde o sponsor, «person snot eqired fo rexpond to an infos ‘oleetion unlesa form diapays a eurvently vali OMB Consol nunber Send ‘Comments garding bude elma or ey ober pec of hi ellestion of informeiion, neloding wiggestins for redicing his Buen, 1: OMe of tne Chief lformation Ofer Forme Management Betach, US. Immipation and Gustor Enforcement. 801 1 ret NW Stop S800, Washington, DC 20836- 5800: Do ot send the frm to this utes Page3 of 3