Westminster College (Fulton - Missouri) Petition as School of Attendance by Nonimmigrant Students with the Department of Homeland Security (DHS) Immigration & Customs Enforcement (ICE) - #Michael Ayele (a.k.a) W

U.S. Immigration and Customs Enforcement Form 1-17 Continuation Page

Certification and Signature by President, Owner, or Head of School

If the school is approved, THE PETITIONER AGREES to maintain SEVIS records and student
records in accordance with 8 CFR 214.2 (f), 214.2 (m), 8 CFR 214.3, 8 CFR 214.4 and 8 CFR 248.

Designated School Official (DSO) means a regularly employed member of the school administration
whose office is located at the school and whose compensation does not come from commissions for
recruitment of foreign students. A DSO may not delegate this designation to any other person. An
individual whose principal obligation to the school is to recruit foreign students for compensation may
not be a DSO. The president, owner, or head of a school system must designate a principal DSO.
The principal DSO is required to have a thorough knowledge of the regulations, policies and
procedures governing nonimmigrant students, and is responsible for ensuring that each additional
DSO has a thorough knowledge of the same.

I, the president, owner, or head of the school or school system named in this petition, certify
that:

1. I am authorized to sign this petition on behalf of this school.
2. The school and its Designated School Officials intend to comply with the regulations listed above.
3. I will be responsible for providing the resources and training necessary for the Designated School
Officials to properly implement the regulations referenced above.
4. I understand that if this institution does not fully comply with the regulatory requirements, approval
may be withdrawn pursuant to 8 CFR 214.4.

5. All of information contained within this petition is true to best of my knowledge.
6. I acknowledge that the submission of inaccurate or misleading information may result in the loss of
my institution's SEVP certification.

7. I understand that willful misstatements may constitute perjury under 18 U.S.C. 1621.
8. I understand that providing materially false, fictitious, or fraudulent information may subject me to
criminal prosecution under 18 U.S.C.1001.

Date Title

06/30/2020 Assistant Director Center for Career Development
Primary Designated School Official

Printed name of President, Owner, or Head Signature
of Srhnol
(b)(6) (b)(7)(C)
(b)(6) (b)(7)(C)

Form 1-17 (Rev 09/30/2016) Page 5 of 5

2020-1CF0-82819 42 of 59

LS. Immigration and Customs Enforcement Form 1-17-A Record of Designated School Officials

Instructions: This section must be signed by all officials listed below.

I, THE UNDERSIGNED, have read the Department of Homeland Security's regulations relating to
nonimmigrant students, namely 8 CFR 214.1, 8 CFR 214.2(f), and/or 8 CFR 214.2(m); the
Department's regulations relating to change of nonimmigrant classification for students, namely 8
CFR 248; the Department's regulations relating to school approval and withdrawal of school
approval, namely 8 CFR 214.3 and 214.4, and intend to comply with these regulations at all times. I
understand that willful misstatements may constitute perjury (18 U.S.C. 1621) and that that
providing materially false, fictitious, or fraudulent information may subject me to criminal
prosecution under 18 U.S.C.1001. Other possible criminal and civil violations may also be

applicable.

Name Role Signature Date

(b)(6) (b)(7)(C) PDSO (b)(6) (b)(7)(C) (b)(6) (b)(7)(C)
_
DSO
0 7/06 72-c)10
DSO
_
DSO
(b)(6) (b)(7)(C)
DSO

Form 1-17 (Rev 09/30/2016) Page lof

2020-1CF0-82819 43 of 59

U.S. Immigration and Customs Enforcement OMB No. 1653-0038

Petition for Approval of School for Attendance by Nonimmigrant Student

Westminster College KAN214F00659000

Section 1: Contact Information

1.1 Approval for Attendance of Students Under:
Section 101(a)(15)(f) of the Act (academic and language students)

1.1a Previous School Code: KAN214F0659.000

1.2 Name of School or School System: Westminster College
1.3 Name of Main Campus: Westminster College
1.4 Mailing Address of the School:

501 Westminster Avenue
Fulton,M0 65251

1.5 Telephone Number: 573-592-5182
1.6 Fax Number: 573-642-2699
1.7 Physical Location of the School:

Westminster College
501 Westminster Avenue
Fulton,M0 65251

1.8 School Type: Private, non-profit
1.9 Private School Owner: Board of Trustrees
1.10 Owner's Address:

501 Westminster Avenue
Fulton,M0 65251

Section 2: Program of Study

2.1 This School is Engaged in:

Higher Education (issuing one or more of the following degrees: Associate's, Bachelor's,
Master's, PhD.)

This school does confer recognized Associates, Bachelor's, Master's, Doctor's, Professional, or
Divinity degrees.
It's credits are recognized by and transferable to institutions of study which confer degrees.

Form 1-17 (Rev 09/30/2016) Page 1 of 5

2020-1CF0-82819 44 of 59

U.S. Immigration and Customs Enforcement Form 1-17 Continuation Page

2.2 Areas of Study:
Liberal Arts
Religious
Professional Studies
Science
Education
Business

2.3 Degrees Available from this School:

Bachelor of Arts (BA)

2.4 Course of Study and Time Necessary to Complete Each:
Bachelor of Art Degrees of study generally require 4 yrs. Majors are: Accounting, Biology,
Biochemistry, Bus Admin, Bus Communication, Chemistry, Computer Sci, Economics,
Education, English, Env Sci, Env Studies, Exercise Sci, French, History, Intn1 Bus, Intn1
Studies,Math, Philosophy, Physical Ed, Physics, Political Sci, Psych, Religion, Self-Designed
Major, Sports Mgmt, Soc/Anthro, Spanish, Transnational Studies. Pre-Professional prgs:
Health & Legal Prof, Pre-Engineering, Pre-law, & dual-degree nursing.

Section 3: Accreditations and Recognitions

3.1 Date School Was Established: 02/18/1851
3.2 Department of Education Recognized Accrediting Agencies:

05/05/2015 - 05/04/2025 North Central Association of Colleges and Schools, The Higher
Learning Commission

3.3 SEVP Identified Accrediting Agencies:
None

3.4 State Recognitions:
05/05/2015 - 05/04/2025 Missouri: Department of Higher Education

33 Optional Comments:
left blank

3.6 FAA Certification:
None

Form 1-17 (Rev 09/30/2016) Page 2 of 5

2020-1CF0-82819 45 of 59

U.S. Immigration and Customs Enforcement Form 1-17 Continuation Page

Section 4: School Calendar, Costs, and Demographics

4.1 This School's Sessions are based on:

Semesters

4.2 Date Registration begins for EACH session during a calendar year:

August 21
January 12

4,3 Sessions are Held: Day
4.4 Average Annual Number of classes: 767
4.5 Average Annual Number of Students: 913
4.6 Average Annual Number of Teachers or Instructors: 87
4,7 Average Annual Number of Non-Teaching Employees: 133
4,8 Approximate Annual Cost of Room, Board, Tuition, etc. per Student: 40800
4,9 Requirements for Admission:Admission to Westminster College is selective and requires the

following: Application for admission, official secondary school transcripts, official transcripts
from post-secondary schools attended, if applicable, scores from the ACT / SAT and / or
TOEFL scores if an international student (minimum score of 550 or consideration for special
admission), a personal essay, and recommendations from a guidance counselor, teacher, or
academic mentor. (See also on-line current WC Student Catalog).

Section 5/6: Campuses and Instructional Sites and Officials

Westminster College Main Campus: Westminster College
Campus 3-digit suffix: 000
Mailing Address: 501 Westminster Avenue, Fulton, MO, 65251-1299
Physical Address: Westminster College, 501 Westminster Avenue, Fulton, MO, 65251-1299
Telephone Number: 573-592-5182 Fax Number: 573-642-2699

Officials Name Title Role Telephone # E-Mail Address
(b)(6) (b)(7)(C) PDSO 573-592 (b)(6) (b)(7)(C)
Director/Assistant
Form 1-17 (Rev 09/30/2016) Dean DSO 573-592

Senior Director of DSO 573-592
Enrollment
Management

Assistant Director
Center for Career
Development

Page 3 of 5

2020-1CF0-82819 46 of 59

U.S. Immigration and Customs Enforcement Form 1-17 Continuation Page

Form 1-17 (Rev 09/30/2016) Page 4 of 5

2020-1CF0-82819 47 of 59

U.S. Immigration and Customs Enforcement Form 1-17 Continuation Page

Certification and Signature by President, Owner, or Head of School

If the school is approved, THE PETITIONER AGREES to maintain SEVIS records and student
records in accordance with 8 CFR 214.2 (f), 214.2 (m), 8 CFR 214.3, 8 CFR 214.4 and 8 CFR 248.

Designated School Official (DSO) means a regularly employed member of the school administration
whose office is located at the school and whose compensation does not come from commissions for
recruitment of foreign students. A DSO may not delegate this designation to any other person. An
individual whose principal obligation to the school is to recruit foreign students for compensation may
not be a DSO. The president, owner, or head of a school system must designate a principal DSO.
The principal DSO is required to have a thorough knowledge of the regulations, policies and
procedures governing nonimmigrant students, and is responsible for ensuring that each additional
DSO has a thorough knowledge of the same.

I, the president, owner, or head of the school or school system named in this petition, certify
that:

1.I am authorized to sign this petition on behalf of this school.
2. The school and its Designated School Officials intend to comply with the regulations listed above.
3. I will be responsible for providing the resources and training necessary for the Designated School
Officials to properly implement the regulations referenced above.
4. I understand that if this institution does not fully comply with the regulatory requirements, approval
may be withdrawn pursuant to 8 CFR 214.4.
5. All of information contained within this petition is true to best of my knowledge.
6. I acknowledge that the submission of inaccurate or misleading information may result in the loss of
my institution's SEVP certification.
7. I understand that willful misstatements may constitute perjury under 18 U.S.C. 1621.
8. I understand that providing materially false, fictitious, or fraudulent information may subject me to
criminal prosecution under 18 U.S.C.1001.

Date Title

/(55 Decr, / io 5

Printed name of President, Owner, or Head Signature rTh

rvf Qr.h"rd

(b)(6) (b)(7)(C)

Form 1-17 (Rev 09/30/2016) Page 5 of 5

2020-1CF0-82819 48 of 59

U.S. Immigration and Customs Enforcement Form I-17-A Record of Designated School Officials

Instructions: This section must be signed by all officials listed below.

I, THE UNDERSIGNED, have read the Department of Homeland Security's regulations relating to
nonimmigrant students, namely 8 CFR 214.1, 8 CFR 214.2(f), and/or 8 CFR 214.2(m); the
Department's regulations relating to change of nonimmigrant classification for students, namely 8
CFR 248; the Department's regulations relating to school approval and withdrawal of school
approval, namely 8 CFR 214.3 and 214.4, and intend to comply with these regulations at all times. I
understand that willful misstatements may constitute perjury (18 U.S.C. 1621) and that that
providing materially false, fictitious, or fraudulent information may subject me to criminal
prosecution under 18 U.S.C.1001. Other possible criminal and civil violations may also be
applicable.

Name Role (b)(6) (b)(7)(C) Dat

(b)(6) (b)(7)(C) PDSO 1 3( / I f
DSO
DSO

Form 1-17 (Rev 09/30/2016) Page I of 1

2020-1CF0-82819 49 of 59

U.S. Department of Justice OMB No. 1653-0038
Immigration and Naturalization Service
Petition for Approval of School for Attendance by
Nonimmigrant Student

START HERE- Please read instructions before beginning. Please type or print in FOR INS USE ONLY
black ink.
School Code 214F
THIS SECTION IS TO BE COMPLETED BY THE SCHOOL. If more space is needed to
answer fully any items on this form, use a separate sheet; identify each answer with the letter and Approval for attendance of students under:
number of the corresponding item and sign and date each sheet. Indicate that an item is not 1. • Section 101(a)(15)(F) of the Act
applicable with "N/A". If the answer is "none,"please write "none." This application must be filed 2. El Section 101(a)(1 5)(M) of the Act
with the required evidence as noted below, be properly signed, and submitted with the correct fee. 3. • Both of the above sections of the Act.

To the Immigration and Naturalization Service: This Request is to:

1. Petition is made for approval, or continuation of approval, of the institution as a school for 1.0 Create a file,
attendance by nonimmigrant alien students under (Complete as appropriate): 2. 0 Update a file.
a. 0 Section 101(a)(15)(F) of the Act (academic and language students),
b.0Section 101(a)(15)(M) of the Act (vocational students), Fee Stamp:
c. 0 Both of the above sections of the Act.

2. Name of school:

Westminster College

3. Mailing address of school:
501 Westminster Avenue
Fulton, MO 65251-1299

4. This school is a:
a. 0Publiely owned institution
b.cIPrivate Institution

5. This school is engaged in: Action Stamp:
a. 0 Private elementary school
b. Private middle school

c. 0 Private high school (grades 9- 12)

d. Public high school (grades 9-12)
e. Vocational or technical education

(other than high school)

f. 0 Flight training

g. 0 Language training

h. El Higher education (issuing one or more of the following degrees: Associate,
Bachelor's, Master's, PhD)

i. 0 Other _

6. This school's sessions are based on:

a. [3 Semesters

b.0Trimesters
c. 0 Quarters

d.0 Other

7. Provide the date (month and day) registration begins for EACH session during a calendar yeat
including the summer session if your school has one. (Format nun/dd)
p.
a. 08/21 f. k.

b. 01/12 g. I. cl. Received Trans In
Ret'd Trans. Out Complete
c. h. m. r.

d. i. n. s.

e. j. o. t.

8. Date school was established: 9. Location of school: (if different from mailing address)

02/18/1851 Westminster College
501 Westminster Avenue
Fulton, MO 65251-1299

10. Name and address of owner: Remarks
Board of Trustrees
501 Westminster Avenue Form 117 (Rev. 10/13/98)N Page I
Fulton, MO 65251-1299

II. Petition is for:
a.0 Initial approval

b.ElContinuation of approval. Please complete the following:

(i.) Date of original approval 01/17/2003
(ii.) INS school code KAN214F00659000

2020-1CF0-8281€4160"dfu59ext Page

12. The School operates under the following federal, state, local or other license or approval (if none, write "none"):
See Continuation Page

13. The school has been approved by the following nationally recognized accrediting association or agency (if none, write "none"):
See Continuation Page

14. Nature of subject matter taught (check as many as are appropriate):

a. 0 Liberal Arts
b. 0 Fine Arts
c. Language
d.El Religious
e. Professional Studies
f. Vocational or Technical Training
8. El Flight Training

Science
Education
Business
Engineering
Other

15. List the degrees available from the school:
BA

16. Check as appropriate and explain further if necessary: does not qualify its graduates for acceptance by accredited schools
lithe school is engaged in elementary or secondary education, it El does 0

of higher educational level.

If the school is engaged in higher education, it El does 0 does not confer recognized bachelor's, master's, doctor's, professional, or divinity
degrees. Its credits ID are 0 are not transferable to institutions of study which confer such degrees.

If the school is engaged in vocational or technical education, it 0 does El does not qualify its graduates for employment.

The school is engaged in English language training.

17. Sessions are held as follows: a. El Day only b. 0 Night only c. 0 Day and night

18.Aao5R5pfde0fpmqiulociiiscrriseaaimocblenolnsentet,ssocfiosodcWrneoadrdeaarmserttiysimossnsfiinroconshfm:tooerortlhCseptorelaAlcenCigTasecl/riaiSspdAmtsTsei,salsenoicdoftfni/i)vc,eoiaaralnpTdOterErasrFnoeLqnsscuaclrioriepersestsssathyfirfe,omaafonndlplioonrswettec-isonrenmgca:motniAeodnpndaparaytlliiocssnactstuhiodofrneoonlmsftoaar(mttgaiendnimmduiesmds,ioscinfo, re of

19. CCCFPorsooeyumunrcrsmchsehe,sus,onRfioHcsefatliutisidsgotytoinuoar,dnyndyC,, thigSImeneemetnl?fnie-s1eDrtcraeByelsls,suyaisgrC,ynroteeImondqcptuo?uMimt1reeaprjlSeoS4ttreu,cyediaS,ricsephE.so:,crMotMsnaoIjMSmo,grismcM:st,,aAtEShco,dccouP/ucAhaninttliitoonhsgnroo,,p,BEhSynio,pglaloPnigshihysyh,,s,iBEcTnaivolracSEhncdesi,nm,aPitsEihtonryyvns,aiSclBstSu,ustduPiAeosdl,mitiEinc,xaeBlrucSsicsei,Sci,

20. Requirements for graduation: College, a student 21. Causes for expulsion: on academic probation when he
To graduate from Westminster A student is placed
or she fails to meet a specified minimum standard
must with respect to their cumulative or term GPA. This
*earn 122 semester hours of course credit, with a serves as a warning to the student tha
minimum GPA of 2.00,
in gNG 103,
*earn credil 111.1M.Vocourses adec9ps: 814 b. Students: 1,070
22. Asy&mg

c. Teachers or instructors:79 d. Non-teaching employees: 139

23. Approximate annual total cost of room, board, tuition, etc., per student : $38,140.00

FonnI47(Rev. 10!13/98)N Page2

2020-1CF0-82819 51 of 59

U.S. Department of Justice Form 1-17 Continuation Page
Immigration and Naturalization Service

Department of Education Recognized Accrediting Agencies:

08/12/2005 -- 12/31/2015 North Central Association of Colleges and Schools, The Higher Learning
Commission

SEVP Recognized Accrediting Agencies:
None

State Recognitions: Missouri:Exempt
N/A -- N/A

Licenses and Other Recognitions:
None

Accreditation/Recognition Comments:

FAA Certifications:
None

Form 1-17 Continuation Page

2020-1CF0-82819 52 of 59

U.S. Department of Justice Form 1-17 Continuation Page
Immigration and Naturalization Service

Form 1-17 Continuation l'age

2020-1CF0-82819 53 of 59

lithe school is approved, THE PETITIONER AGREES:

1. Upon acceptance of any nonimmigrant alien student, to furnish that student a Certificate of Eligibility (Form 1-20 A/B for an F-1 student or Form
1-20 M/N for an M-1 student).

2. Tstrsrhcceeohghespukooroleoeoanpelltposimioisrbrsntueulissencetogafskrotrader8eesmFqCpcuoaoRariirnmnnFetdtmaa21mii1-enn2n4aii0ntn.ks3gMge,ftottahBhhrveaeaaostftieroltlahel1rbleae-ol2cssweo0ttutrioMonddngstee/hnNsfyeopt,elSiewlascoernhiwr.fvoiiilIcinelcfoigetannhrufsgeoeptercusormetdnuipepadurntteeritonoqswuntfuiinheanssoongtatdiittasfthdiecfoeonuaucfdlttouliionolcmlnogfoeuwsftnrthraitosenstemugsrocseithfnlihasosfettooriuSrnledmegsaytrntao.vodtriiTeceoudeanhnctettaohhinslascndttthhoatdoenhtouoiesmcslcsu,hmtmtmuohuidoeegsenlrtsnnatckstnohehtftoeoiaFofprsi-leeaIbtsaherotceeehrhncseMotnruSroe-ddes1nrteoiovnmsfrtitucemhieddsai,evgtainorintnattseagnttnocatcdctowFuoimn-srh1.gdopaaiTmlsninehdctdeeh/owewriiMtthh-1
student:

1. The admission number from the student's Form 1-20 ID copy.

2. Country of citizenship.
3. Address and telephone number in the United States.
4. Status, i.e. full-time or pan-time.

5. Course load.
6. Date of commencement of studies.
7. Degree program and field of study.
8. Expected date of completion.
9. Nonimmigrant classification.
10. Termination date and reason, if known.
11. The documents which show the scholastic ability and financial status on

which the student's admission to the school was based.
12. Information specified by the Service as necessary to identify the student

and to determine the student's immigration status.

3. That in any advertisement, catalog, brochure, literature, or other material produced by or for this school, any statement which may appear law to
concerning approval for admittance by nonimmigrant students must be limited to the following: "This school is authorized underFederal

enroll nonimmigrant students."

I certify that lam authorized to execute this petition. I understand that unless this institution fully complies with all terms as described on this form,
approval may be withdrawn pursuant to 8 CFR 214.4.

2-,this ' f(
Dated at: C‘11 kaki day of PIA-ra,
Signature:
b)(6); (b)(7)(C)

Name and Tit e0-43, Cr/ Di ti-er; /-4-i e-e4tkr

(CORPORATE SEAL
OF INSTITUTION)

Form 1-17 (Rev. 10/13/98)N Page 3

2020-1CF0-82819 54 of 59

U.S. Department of Justice OMB No. 1653-0038
Immigration and Naturalization Service
Record of Designated School Officials

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Office having jurisdiction over the school within thirty days.

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same.

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with these regulations at all times.

Designated Official: (Print or Type) Signature: Telephone Number: Role:
573- 592_(b)(6); (b)(7)(C) PDSO
Last and First Name: Title:

(b)(7)(C) Director of the Diversity

Center

['Initial Designation 1:1 Replacement for prior designated official 0 Correction to previous designation

Designated Official: (Print or Type) ephone Num11r Role:
rivet Unroll..
(b)(6); (b)(7)(C) Title: Direcfcr",-L-r-Sign b)(6); (b)(7)(C) 573-51 (b)(6); (b)(7)(C) DS

ro If m Narutlait

*initial Designation Replacement for prior designated official 13 Correction to previous designation

Designated Official: (Print or Type) signature: (b)(6); (b)(7)(C) 'elephonc Number: Role:

I arkel Piret Tismie• Talc 4eSielt44 (NW

(b)(6); (b)(7)(C) 5'73 .. CD

()1((76);Cc)

At Initial Designation Li Replacement for prior designatea Correction to previous designation

Designated Official: (Print or Ty/ e) (b)(6); (b)(7)(C)
Signaturt:
T wet end Piret NAM, ' A4 Pro 1OUne . 5-1 (b)(6);
Z (b)(7)(C)
(b)(6); (b)(7)(C)

LI Replacement for prior designa Correction to previous designation

Designated Official: (Print or Type) elephone Nur(6)(6); (b)(7)(C) Role:
wAehsasttt.TAoifst:ltAe.N•o.i6/b4i&t • ryeSvvigitnAa,i- (b)(6); (b)(7)(C)
(b)(6); (b)(7)(C) 1)To

,c,l_lLnIsa. •-ovva El Replacement for prior de ignaico oi uciat 0 Correction to previous designation

Designated Official: (Print or Type) Title: Signature: Telephone Number: Role:

Last and First Name:

0 Initial Designation CI Replacement for prior designated official ID Correction to previous designation

Designated Official: (Print or Type) Title: Signature: Telephone Number: Role:

Last and First Name:

El Initial Designation 13 Replacement for prior designated official El Correction to previous designation
2020-1CF0-82819 55 of 59 Form 1-17A (Rev. 10/13/98)Supplement A Page 1

Designated Official: (Print or Type) Telephone Number: Role:

Last and First Name: Title: Signature:

0 Initial Designation 0 Replacement for prior designated official 0 Correction to previous designation

Designated Official: (Print or Type) Telephone Number: Role:

Last and First Name: Title: Signature:

13 Initial Designation 0 Replacement for prior designated official Correction to previous designation

Designated Official: (Print or Type) Telephone Number: Role:

Last and First Name: Title: Signature:

, • Replacement for prior designated official I Correction to previous designation
• Initial Designation

Designated Official: (Print or Type) Signature: Telephone Number: Role:

Last and First Name Title:

• Initial Designation • Replacement for prior designated of II Correction to previous designation

Designated Official: (print or Type) Signature: Telephone Number: Role:

Last and First Name: Title:

• Initial Designation 0 Replacement for prior designated official • Correction to previous designation

Designated Official: (Print or Type) Telephone Number: Role:

Last and First Name: Title: Signature:

0 Initial Designation 0 Replacement for prior designated official 0 Correction to previous designation

Designated Official: (Print or Type) Title: Signature: Telephone Number: Role:

Last and First Name:

, 0 Replacement for prior designated official • Correction to previous designation
• Initial Designation

Designated Official: (Print or Type) Signature: Telephone Number: Role:

Last and First Name: Title:

• Initial Designation 0Replacement for prior designated official • Correction to previous designation

Designated Official: (Print or Type) Signature: Telephone Number: Role:

Last and First Name: Title:

• Initial Designation • Replacement for prior designated official • Correction to previous designation

Designated Official: (Print or Type) Signature: Telephone Number: Role:

Last and First Name: Title:

II Initial Designation • Replacement for prior designated official • Correction to previous designation
2020-1CF0-82819 56 of 59 Form I-17A (Rev. 10/13/98)Supplement A Page 2

Designated Official: (Print or Type) Signature: Telephone Number: Role:

Last and First Name: Title:

0 Initial Designation 0 Replacement for prior designated official 0 Correction to previous designation

Designated Official: (Print or Type) Signature: Telephone Number: Role:

Last and First Name: Title:

0 Initial Designation 0 Replacement for prior designated official 0 Correction to previous designation

Designated Official: (Print or Type) Signature: Telephone Number: Role:

Last and First Name: Title:

., • Replacement for prior designated official • Correction to previous designation
• Initial Designation

Designated Official: (Print or Type) Title: Signature: Telephone Number: Role:

Last and First Name

II Initial Designation 10 Replacement for prior designated official • Correction to previous designation

Designated Official: (print or Type) Signature: Telephone Number Role:

Last and First Name: Title:

i Initial Designation IN Replacement for prior designated official III Correction to previous designation

Designated Official: (Print or Type) Telephone Number: Role:

Last and First Name: Title: Signature:

0 Initial Designation • Replacement for prior designated official III Correction to previous designation

Designated Official: (Print or Type) Title: Signature: Telephone Number: Role:

Last and First Name:

• Initial Designation III Replacement for prior designated official MI Correction to previous designation'

Designated Official: (Print or 7'ype) Signature: Telephone Number: Role:

Last and First Name: Title:

El Initial Designation 0 Replacement for prior designate(l official El Correction to previous designation

Designated Official: (Print or 1)ipe) Title: Signature: Telephone Number: Role:

Last and First Name:

• Initial Designation • Replacement for prior designated official • Correction to previous designation

Designated Official: (Print or Type) Title: Signature: Telephone Number: Role:

Last and First Name:

. Initial Designation • Replacement for prior designated official • Correction to previous designation
Form 1-17A (Rev. 10/13/98)Supplement A Page 3

2020-1CF0-82819 57 of 59

Designated Official: (Print or Type) Signature: Telephone Number: Role:

Last and First Name: Title:

0 Initial Designation 0 Replacement for prior designated official O Correction to previous designation

Designated Official: (Print or Type) Signature: Telephone Number: Role:

Last and First Name: Title:

0 Initial Designation 0 Replacement for prior designated official • Correction to previous designation

Designated Official: (Print or :type) Signature: Telephone Number: Role:

Last and First Name: Title:

0 Initial Designation 0 Replacement for prior designated official O Conection to previous designation

I, the undersigned president, owner, or head of the school or school system named below certify that the above individuals are designated school
officials of the school or school system. Further, I certify that I will be responsible for providing the resources and training necessary for these

officials to implement properly the above referenced regulations.

(b)(6); (b)(7)(C) r bi (b)(6); (b)(7)(C)
Name wrint or iypej Signature
Title (Print or 1)pe)

Name of School System, School, or Campus (list all schools or INS FILE No. if known: 214F
campuses and their three-digit suffixes for which the above
officials arc designated if for more than one school or campus but Date:
not for the entire school system). (If a multi-campus institution or school system use the 3 digit suffix

for the main or initial campus.)

Westminster College
Westminster College
000

Address of School System, School, or Campus:

501 Westminster Avenue
Fulton, MO 65251-1299

Form I-17A (Rev. 10/13/98)Supplement A Page 4

2020-1CF0-82819 58 of 59

U.S. Department of Justice OMB No. 1653-0038
Immigration and Naturalization Service Record of School/Campuses

Instructions — Form I-17 Supplement B must be completed and submitted with Form1-17 if a school system or multi-campus institution is
seeking approval for a number of schools for admittance by nonimmigrant students. Furnish all known information for each school or campus
within the system. If more space is needed to list all schools, attach additional forms as necessary, and number each at the bottom. If an approved
school system wishes to update or correct the information on its original Supplement B, a new Form I-17, must be submitted, without fee,
accompanied by Supplement B, and, if applicable, Supplement A. Please PRINT or TYPE all information on this form.

Request Action: Initial approval for the following school(s) or campus(es).
a. El Addition of the following school(s) or campus(es) to the list of approved institutions within the above school system.
b. 0 Removal of the following school(s) or campus(es) from the list of approved institutions within the above school system.
c. 0
d. 0 Change or correction in the following information relating to school(s) or campus(es) which have been approved.

Fill in only the information which is to be added to or adjusted in the INS records, and the school's three-digit suffix:

1. School or Campus Name: 2. School or Campus 3-digit suffix:

Westminster College 000

3. Mailing Address: (include Zip Code) 4. Location: (if different from mailing address)

501 Westminster Avenue Westminster College
Fulton, MO 65251-1299 501 Westminster Avenue
Fulton, MO 65251-1299

1. School or Campus Name: 2. School or Campus 3-digit suffix:
3. Mailing Address: (include Zip Code)
4. Location: of differenI.froni mailing address)

1. School or Campus Name: 2. School or Campus 3-digit suffix:
3. Mailing Address: (include Zip Code) 4. Location: (( difjerent from mailing address)

1. School or Campus Name: 2. School or Campus 3-digit suffix:
3. Mailing Address: (include Zip Code) 4. Location: (f different from mailing address)

FormI-17B(Rev.10/13/98)Supplementli Pagel

2020-1CF0-82819 59 of 59