Certificate of Eligibility for Nonimmigrant(F-1) Student Sta

U.S. Department of Justice美国司法部 第 1 页 Immigration and Naturalization Service公民和移民服务局

Certificate of Eligibility for Nonimmigrant (F-1) Student Status - For Academic and Language Students (OMB No. 1653-0038) 非移民 (F-1) 学生的资格证书学生身份---学历和语言学习（OMB No. 1115-0051）

Please Read Instructions on Page 2请阅读第2页上的细则

This page must be completed and signed in the U.S. by a designated school official.本页必须在美国境内由指定的学校管理人员填写、签署

1. Family Name (surname) 姓：段

First (given) name 名：慧 Middle name名的中间字： Country of birth 出生国：中国 Date of birth出生日期：1993年11月5日 Admission number 入学号

2. School (school district) name 学校 (校区) 名称：纽约州立大学布法罗分校

School official to be notified of student's arrival in U.S. (Name and Title) 管理学生入美的指定学校官员(姓名及职位)

School address (include zip code) 学校地址(包括邮递区号)：

School code (including 3-digit suffix, if any) and approval date 学校编码(包括最后 3 位数,如有)及批准日期：

3. This certificate is issued to the student named above for: 特此本证明颁发给上述姓名的学生，以：

4. Level of education the student is pursuing or will pursue in the United States: BACHELOR’S学生目前或将要在美国取得的教育水平：学士

SEVIS〈美国〉留学生及交流访问学者信息系统 For Immigration Office User 由移民官填写 Student’s Copy学生的复本 Visa issuing post签证发放地 Date visa issued 签证颁发日期 Reinstated, extension granted to:

5. The student named above has been accepted for a full course of study at this school, majoring in Economics, General. The student is expected to report to the school no later than 01/20/2014 and complete studies not later than 02/01/2017. The normal length of study is 36 months.

现已同意上述姓名的学生在本校进行全时学习，专业为：经济学；学生将在不晚于2014年1月20日入学， 最迟于2017年2月1日完成学业；正常的学期为36个月。

6. English proficiency: 英语程度 This school requires English proficiency. The student has the required English proficiency.

7. This school estimates the student's average costs for an academic term of____________ (up to 12) months to be: 本学校预计的学生每学年(12个月)的平均费用为： a. Tuition and fees学费 b. Living expenses生活费

c. Expenses of dependents家眷的费用 d. Other(specify): 其他(细则) Total 总额

8. This school has information showing the following as the student’s means of support, estimated for an academic term of __________ months. 本校已持有学生财力支持的以下信息 (以每个学年 个月计) (同第7条)。 a. Student's personal funds学生个人资金 b. Funds from this school学校资金 Specify type: 具体类型:

c. Funds from another source (specify type) 其他来源的资金（具体类型）：家庭 d. On-campus employment校内务工 Total总额

9.Remarks意见

10. School Certification: I certify under penalty of perjury that all information provided above in items 1 through 9 was completed before I signed this form and is true and correct; I executed this form in the United States after review and evaluation in the United States by me or other officials of the school of the student's application, transcripts or other records of courses taken and proof of financial responsibility, which were received at the school prior to the execution of this form; the school has determined that the above named student's qualifications meet all standards for admission to the school; the student will be required to pursue a full course of study as defined by 8 CFR 214.2 (f)(6); I am a designated official of the above named school and am authorized to issue this form. 【10. 校方证明：就伪证罪我特此证明：本表格1---9项信息都是在我签署前填写、并且是正确和真实的。在我与学校的其他管理人员对学生的申请函、已学课程记录及其财力担保证明等材料（这些材料是在发出本表前由校方收到的）进行审核和评诂后，由我在美国填写校方内容：校方认为上述姓名的学生完全符合入学要求；并依据 8CFR 214(f)(6) 规定，要求学生在校全时学习。我是上述校方的指定管理人员，并被授权签发本表。】

International admission’s advisor国际招生顾问 Name of school official 学校官方名称

Signature of designated school official指定的校方官员签名 Title职衔 Date issued 签发日期

Place issued (city and state)签发地点（州/城市）

11. Student Certification: I have read and agreed to comply with the terms and conditions of my admission and those of any extension of stay as specified on page 2. I certify that all information provided on this form refers specifically to me and is true and correct to the best of my knowledge. I certify that I seek to enter or remain in the United States temporarily, and solely for the purpose of pursuing a full course of study at the school named on page 1 of this form. I also authorize the named school to release any information from my records which is needed by the INS pursuant to 8 CFR 214.3(g) to determine my nonimmigrant status.

【11. 学生证明: 我已阅读并同意在本表第2页上、关于我入学及任何可能的延期滞留的规定和条件，我特此证明以上有关我个人的信息都是真实且正确的。我证明：进入美国或暂时留在境内的唯一目的就是要完成在表格第1页中所列学校的全时学习；并且依据 8CFR214 3（g）的规定，因移民局决定我身份之需要， 我也授权上述学校可以对其公开我档案中的任何信息。】 Name of student 学生姓名

Signature of student学生签名 Date 日期

Signature of parent or guardian父母/监护人的姓名 if student is under 18 如果学生不满18岁

Signature of student Name of student父母/监护人的签名

Address 地址(城市) （state or province） (州/省) (country国家) Date 日期

Form 1-20 a-b (Rev.04-27-88)N 表1-20 a-b (Rev.04-27-88)N For official use only仅限官方使用

Microfilm index number 索引号，可以不翻译

Northeastern university东北大学

The international student and scholar institute（issi）welcomes you to the northeastern community国际学生和学者研究所(issi)东北部社区欢迎你

Enclosed please find a certificate of eligibility（1-20）that is used to apply for an f-1 student visa and to enter the united states in f-1 status。Please take a minute to look at the sample below and review the information on your own 1-20。You will also find a guide to applying for the f-1 visa enclosed。If you have any questions about your 1-20 or obtaining your f-1 visa，please contact the issi。在里面你会找到资格证书，用于申请f - 1学生签证并且在拿到f-1签证的情况下进入美国.请花一分

钟,看看下面的示例，审查一下自己1-20的信息.-里面还有一份申请f - 1签证指南，如果你有任何关于1-20的问题或关于获得f - 1签证的问题,请联系ISSI

左边：your biographical information你的履历

School information（can be used as contact information for visa application）学校信息（可被用作申请签证的联系信息）

Program CIP cod title（may differ from the name of your neu program）美国高校专业目录代码（区别于你在美国东北大学的名称） Program and date学院和日期

Issi advisor‘s signature国际学生和学者研究所指导老师的签名

Write your name，sign and date here（above the line）写下你的姓名，签名，日期（在横线以上）

右边：sevis id number学生和交流访问者信息系统账号

Program start date（you can arrive in the us up to 30 days before，but no later than this date） Funding shown by student学习开始时间（你可以提前30天到达美国，但是不要晚于这个日期）

Estimated program expenses for first year 预计的第一年的学费

The program title on the 1-20 reflects the cip（classification of instructional programs）code which is assigned to the northeastern program by the registrar‘s office based on a list of possible

programs of study created by the us。Department of education。The cip code is also shown at the top of page 3 of the 1-20

1-20中的学校代码反映了美国高校学科专业目录的代码，它是注册处基于一系列可能的美国教育部创建的学习计划来分配给东北大学的。这个代码也在1-20的第三页的最上方有所展示

For example：cps regulatory affairs = cip code51.2002 pharmacy administration and pharmacy policy and regulatory affairs

举例：CPS规范=cip代码51.2002药品管理，药品政策和法律法规

Important：if you are not able to arrive on campus before your program start date（item #5），you must contact your admissions department to get approval to arrive to campus late or to defer your acceptance to the next available term

注：如果你不能提前与开学日期到达学校，你必须与招生部门取得联系得到晚到校的允许或者取得推迟到下学期到校的许可

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