F-1 I-20 Application – Associate degree

1 form 125-043. Rev. 6/18. Pg. 1 of 2. F-1 I-20 Application Associate degree This form , along with the other forms and documents required for the I-20, should be mailed or taken directly to: Office of International Student Services 7630 Little River Turnpike Suite 405. Annandale, VA 22003. Please complete both pages of the form . Name: Family Name First Name Middle Name Date of Birth: EMPLID #: Month / Day / Year Gender (male/female): Country of Birth: Are you currently in the United States?: Yes No Country of Citizenship: If yes, what is your current visa status?

2 : When does your currentstatus expire?: In which semester do you want to begin your studies at NOVA? Spring (January) Fall (August). Program of study: See Provide Evidence of English proficiency: (Check one). Students applying to begin studies in the Associate degree program must provide evidence of English proficiency to be admitted and obtain an I-20 for the degree program Note: All students (American and International) must take an English proficiency test before registering for classes at NOVA. The English proficiency test may be waived if you have a TOEFL iBT score of 95 or have completed the equivalent of ENG 111 as described below.

3 You can meet the English proficiency requirement for obtaining an I-20 in one of the following ways: English is one of my primary languages. I have taken the English placement test at a Testing Center on any NOVA campus and received a score of Level 4 or higher. I have taken one of the following tests within the past two years: (official score must be sent to NOVA). o TOEFL: IBT 61 or higher* Score: TOEFL: CPT 173 or higher Score: TOEFL: PBT 500 or higher Score: o IELTS: Academic or higher Score: *Students who submit an IELTS score must have taken the Academic IELTS.

4 NOVA does not accept scores from the General Training IELTS. o PTE: Academic 44 or higher Score: o SAT: Critical Reading and Writing subtests 500 on each test Scores: o ACT: English and Writing subtests 21 on each test Scores: I have studied at an ELS Language Center ( ) and passed Level 112. A copy of the certificate needs to be submitted with your Application . Certificates are subject to verification with the ELS Language Center. I have studied at a college or university whose credits are accepted by NOVA. An original transcript in a sealed envelope must be mailed by the college/university directly to the Office of International Student Services (not to a NOVA campus).

5 The transcript must show that you have taken the equivalent of our ENG 111 as part of a full-time course load (12 credits. You must have received a C or better in the English class and have a cumulative GPA of or better. All transcripts are subject to verification. form 125-043. Rev. 6/18. Pg. 2 of 2. Which campus of NOVA do you wish to attend? ___ Alexandria ___ Annandale ___ Loudoun Manassas Medical Education Campus Woodbridge Student's email address: Communication will be by email. Please check your account regularly.)

6 Note: We have experienced difficulty sending attachments to or Please provide another account if you have one. Permanent Address Outside (This information is required for I-20): Street Address: Postal Code: City: Country: Province: Address (if known): Street Address: State: City: Zip Code: Information about Dependents: I plan to come alone. I will be accompanied by the following dependents. Please make sure that the names are written very clearly. (Dependents can only include spouse and/or children): Name: Relationship: Spouse Child Date of Birth: / / Gender: Female Male Month/Day/Year Country of Birth: Country of Citizenship: Name: Relationship: Spouse Child Date of Birth: / / Gender: Female Male Month/Day/Year Country of Birth: Country of Citizenship: Name: Relationship: Spouse Child Date of Birth: / / Gender: Female Male Month/Day/Year Country of Birth: Country of Citizenship: (Please make additional copies if you have more dependents).

7 Name of person completing this form : Email address: Telephone number: I promise that the information which I have written on this form is correct and that I was authorized by the student to prepare this form . Signature: Date: Please check below the manner in which you want OISS to send the I-20 to the student: Please mail the I-20 to the address. Please mail the I-20 to the address outside the Please include telephone number of this address to help with express mail Please call for pick up. Telephone number.