International Student (F-1) Agreement
Undergraduate and Graduate International Students
Part 1
The following information is required in order to correctly produce a student I-20:
UHV ID Number:
First (Given) Name:
Middle Name:
Family (Surname) Name:
Suffix (Jr., Sr., etc.)
Date of Birth: Month:
Day:
Year:
Country of Birth:
Sex:
 Male
 Female
Country of Citizenship:
Email Address:
Beginning Semester at UHV:
 Fall 20____
 Spring 20____
 Summer 20____
Permanent International Address: (This is required to complete the I-20)
Address:
Address:
City:
Province/Territory:
Postal Code:
Country:
Telephone Number:
U.S Address: (for U.S. transfer International Students or Change of Status Students)
Address:
Address Line 2:
City
State, Zip:
Telephone Number: (
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I am applying as:
My Primary Major is: _________________________________
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Freshman
ESL On-Demand
International Undergraduate Transfer
U.S. Undergraduate Transfer
Exchange/Sponsored Programs
□ Graduate
Concentration: _________________________
You MUST select a program/major from the International Programs Office
approved program guide:
http://www.uhv.edu/international/how-to-apply/academic-majors-guide/
Please note: All UHV catalog programs are not available for students seeking
F-1 Admission.
Which UHV Campus location do you plan to attend?
University of Houston – Victoria offers degrees and classes at the three locations in Texas. Students who apply
for UHV will obtain their degree from University of Houston – Victoria. Please chose the campus location you
wish to attend:
 Victoria, Texas (student housing is available) – All Undergraduate and Graduate
 UH System at Katy, Katy, Texas (student housing not available) - Upper division Undergraduate Classes and
Graduate MBA, Graduate Computer Science
TRANSFER INTERNATIONAL STUDENTS
(Transferring from another U.S. institution or seeking Change of Status)
Name of the U.S. institution you are transferring from?
Current U.S. visa type:
Are you seeking a Change of Status to F-1?  Yes  No
I-20 Expiration Date:
I-94 Number:
Are you in Good Academic and Immigration Standing?
If not, why?
Are you currently on OPT?
 Yes
 No
If Yes, Please list the OPT end date:
_______________________
Please note, once the transfer to UHV is complete, the existing
OPT will be canceled. If you plan to work until the end date of
your OPT or if you plan to enroll prior to the end date of your
OPT, please inform UHV International Advisors via email at
[email protected], please include your ID in all email
communications to UHV.
Do you have a work authorization through Economic
Hardship  Yes
 No
If yes, I understand that economic hardship approved through
my current U.S. institution will not carry over to UHV. The work
authorization through my current U.S. institution will cancel once
the SEVIS transfer is complete and work authorization will no
longer be valid regardless of the expiration date of the work
authorization.
Student Signature:_____________________
Date: _____________________
Dependent Information
Will immediate family members (spouse or children) come to the U.S. with you?
 Yes  No
If Yes, please provide the following information for each person. (If more than 3, copy this page and attach it to this form.)
Dependent 1
Family Name:
First Name:
Middle Name:
Relationship to
Student:
Male or Female?
Date of Birth:
Country of Birth:
Country of
Citizenship:
Dependent 2
Dependent 3
UNDERSTANDING INTERNATIONAL STUDENT REQUIREMENTS
Part 2
Please read the following requirements
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I understand that if English is not my native language I must satisfy the University’s English requirement for
international students prior to admission. See the online Admissions for International Students information
regarding English proficiency for English Proficiency waiver requirements.
I understand that if I am admitted to the university, I may be tested again for my English proficiency on a
specified date at the university.
I understand that I am responsible for my own accommodations (housing, meals, travel and transportation)
and that housing is only available at the campus in Victoria, Texas. Housing arrangements for students
attending Katy, Texas campus locations must be made prior to entry to the United States.
I understand and agree that I will present satisfactory evidence of health/medical coverage under a U.S.
major medical health insurance plan, including medical evacuation and repatriation coverage, or agree to
pay for university endorsed insurance coverage before I will be permitted to register. Failing to provide
evidence of health/medical coverage will result in an automatic enrollment for the UHV sponsored
Health/Medical Insurance plan. I understand that if I am an Athlete, interscholastic, professional and semiprofessional injuries are not covered by the UHV sponsored health/medical coverage.
I understand that all documents and materials related to my admission (including the International Student
Agreement, Letter of Financial Sponsorships and Bank statements/documents) must be translated to
English and forwarded to the International Programs Office. I also understand that UHV may contact
international universities I have previously attended to verify degree, enrollment, and school documents
from that institution.
I understand that I am responsible for the funds necessary to cover my (including all dependents) entire
expenses during my time at University of Houston – Victoria. The Univesity of Houston-Victoria reserves
the right to change without notice tuition, fees, payment, requirements and regulations as necessitated by
University of legistative action.
I agree to comply with the payment policies and deadlines set forth by University of Houston – Victoria for
the University of Houston- Victoria billed expenses. I understand that I am able to make payments to UHV
through Transfer of bank funds, International Draft, Money order, American Express, Mastercard or
Discover cards. Visa credit cards are not accepted by UHV for payments. I understand that failing to make
the necessary payments to UHV will result in a termination F-1 immigration status.
I understand that I must comply with all F-1 policies and regulations during my time at UHV. I understand
that I will attend mandatory orientation that will cover my responsibilities as a F-1 student.
I understand that I must report to a campus location on or before the date specified on my Form I-20. (To
postpone registration until the following semester, you must contact the International Programs Office prior
to the start date on the I-20.)
I understand that I will not engage in off-campus employment or business activities without authorization
from the U.S. Citizenship and Immigration Services.
I understand that I will maintain satisfactory academic progress by maintaining my program requirement
grade point average and class attendance. Failing to maintain satisfactory academic progress will result in
temination of your F-1 status.
By submitting this form, I certify that the information submitted is complete and accurate. I further
understand that providing inaccurate information can be considered sufficient cause for rejecting
my application or terminating my enrollment at University of Houston-Victoria.
Student Full Name (print) : _______________________________________ UHV ID: _______________
_________________________________________________
Student Signature (do not type)
________________
Date
LETTER OF FINANCIAL SPONSORSHIP
Dear Sponsor (s): Please complete the form and submit along with an official bank statement indicating
the US$ amount of sponsor. If more than one sponsor is sponsoring the student, each sponsor must
submit this form along with official bank statements/documents.
Name of the student you are sponsoring: ______________________________________________
Student UHV ID number: __________________________________________________________
Sponsor Full Name: ______________________________________________________________
Relationship status to the student (i.e. Father, Mother): ___________________________________
Sponsor Address: ________________________________________________________________
City, Country, Postal Information: ______________________________________________
Sponsor Phone Number: __________________________________________________________
Total Dollar amount the sponsor will be sponsoring for the above student: US$________________
Are you sponsoring other students in the United States?
Yes
No
If yes, list the number of students sponsoring? _______
What institutions the students are attending? ___________________________________________
Documents that needs to be submitted along with this form:
 You must include current bank documents, translated in English, from bank or financial institution for self or
sponsor verifying the minimum amount of funds required, stated in U.S. dollars. The bank
statements/document must be on an official bank letterhead with sponsor name/balance listed on the body of
the letter.
 The official bank statements/documents must be less than six (6) months of the date of issue. If your sponsor
is a U.S. citizen or U.S. permanent resident, you must provide a notarized copy of USCIS form I-134 Affidavit
of Support along with the required bank documents. You can locate the I-134 at www.uscis.gov/i-134
By submitting this form, I certify that the information submitted is complete and accurate. And with my
signature below I agree to sponsor the above student with their annual expenses at University of
Houston – Victoria. I further understand that providing inaccurate information can be considered
sufficient cause for the rejection of the student/applicants application or termination of the
student/applicants enrollment at University of Houston – Victoria.
____________________________________________________________
Sponsor Name in Full (Print Clearly)
_____________________________
Date
_________________________________________________
Sponsor Signature
Please mail this form along with official bank statement (s) to:
University of Houston-Victoria
International Programs Office
University West Suite 228
or
Scan and Email to [email protected]
3007 N. Ben Wilson St.
Victoria, TX 77901