. 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）
Plea Read Instructions on Page 2请阅读第2页上的细则
This page must be completed and signed in the . 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
新年的
School official to be notified of student's arrival in . (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 Ur 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 cour 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 expens生活费
c. Expens of dependents家眷的费用
如何培养自信心
d. Other(specify): 其他(细则)蒜蓉粉丝龙虾
摄影知识Total 总额
腹泻草8. This school has information showing the following as the student’s means of support, e
赞美医护人员
stimated 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
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 corre茶花的功效与作用
ct; 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 cours 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 cour of study as defined by 8 CFR (f)(6); I am a designated official of the above named school and am authorized to issue this form.
【蔺相如廉颇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 tho 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 ek to enter or remain in the United States temporarily, and solely for the purpo of pursuing a full cour of study at the school named on page 1 of this form. I also authorize the named school to relea any information from my records which is needed
by the INS pursuant to 8 CFR (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
Authority for collecting the information on this and related student forms is contained in 8 1101 and 1184. The information solicited will be ud by the Department of State and the Immigration and Naturalization Service to determine eligibility for the benefits requested.
