Center for International Career Development 4530 Union Bay Place NE, Suite 214 Seattle WA 98105, USA

Phone: 206-957-7112, Fax: 206-527-033 E-mail: swt@cicdgo.com, Web: www.cicdgo.com

Student Status Verification Form

This form is necessary to confirm that the student below is a bone fide University student in their home country, so that CICD can allow the students participation in the Summer Work & Travel program in the USA. A university official should sign this form and provide a University Stamp. * This form is not valid without the University stamp or without a University Official signature.

University Officials: I/We the undersigned confirm the following: Students Name: Students Field of Study: Student Started Studies on: Expected Graduation Date: University Summer Vacation Dates: (month/day/year): (month/day/year): From: (month/day/year): To: (month/day/year):

University Officials: I/We the undersigned confirm that the student listed above is a full-time student at: University Name: University Street Address: City: Email Address: Country: Phone Number: Postal Code:

Signature of University Official

Date

Printed Name of University Official

Official Stamp/Seal of University