ds 11 form 2014

MEDICAL EXAMINATION FOR EXPIRATION DATE

Treated If treated, therapy: Yes Other (therapy, dose): Benzathine penicillin, 2.4 MU IM No Date(s) treatment given (mm-dd-yyyy) (3 doses for penicillin)

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International Financial Support Form 2013 2014

International Financial Support Form Page 1 To obtain a Certificate of Eligibility (I-20 or DS-2019), all international applicants must demonstrate their ability to

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TRAINING INTERNSHIP PLACEMENT PLAN State

Printed Name of Supervisor Date (mm-dd-yyyy) Signature of Supervisor Sponsor - I certify as the sponsor that the attached Training/Internship Plan is approved and that:

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