Fillable DOCUMENT REQUEST FORM (University of Denver)

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DOCUMENT REQUEST FORM (University of Denver)

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International House
2200 S. Josephine St. Denver, CO 80208
Phone:303-871-4912 Email: isss@du.edu
FOR ISSS OFFICE USE ONLY
Assigned To:
Processing Checklist:
Processing Notes
☐ Enrollment checked by ________
☐ GA processed ____ /____ /____
☐ ISA processed ____ /____ /____
DOCUMENT REQUEST FORM
Section A: Student Information
DU ID:
LAST (FAMILY) NAME:
FIRST NAME:
I hereby authorize the release of any information necessary and authorize any changes needed to complete my request.
STUDENT SIGNATURE:
I cannot pick up my documents and have attached the Mailing Authorization Form with this Request.
ISSS will send all communications about this request to your @du.edu email. Remember to check this account regularly.
SECTION B: Please Indicate Document(s) Needed:
General Requests:
☐ Certification for a Social Security Number for On-campus Employment*
*Refer to the ISSS website: http://www.du.edu/isss/employment/ssn.html for instructions and sample employer letter.
☐ New I-20/DS-2019 for travel (ISSS cannot sign I-20s/DS-2019s for travel while the university is closed)
Dates leaving and returning to the U.S. (mm/dd/yy): _____ /_____ /_____ to _____ /_____ /_____
☐ Other (please list): ____________________________________________________________________
Requests for F-1 Students Only:
☐ New I-20 (Complete Part C)
☐ Economic Hardship Employment Authorization
(Please meet with ISSS Advisor)
Requests for J-1 Students Only:
☐ New DS-2019 (Complete Part C)
☐ Economic Hardship Employment Authorization
(Please meet with ISSS Advisor)
COMPLETE SECTIONS C+D ONLY IF YOU HAVE REQUESTED A NEW I-20/DS-2019
SECTION C: Reason for Requesting New I-20/DS-2019
☐ Re-entry to US after temporary absence: Expected date of re-entry: _____/_____/_____ (Complete Part D)
☐ Replacement: Reason for Replacement: ☐ Lost ☐ Stolen ☐ Damaged ☐ Updated
☐ Addition of dependents (spouse/children): Expected date of entry to U.S.: _____/_____/_____ (Complete Parts D & E)
☐ Out of status: Please make an appointment with an ISSS advisor
☐ Change of status: From (status): _____ To (status): _____ Expected Completion Date ____/____/____ (Complete Part D)
Refer to the ISSS website: http://www.du.edu/isss/visa-immigration/changeofstatus.html for instructions and forms
☐ Return SEVIS Record to DU from another school: Expected start date at DU: _____/_____/_____
Complete and submit the Transfer-In Form at https://www.du.edu/isss/forms/sevis-transfer-in.pdf
☐ Change in: ☐ Major ☐ Source of funding (Please complete Part D)
☐ Dependent information (Please complete Part E)
☐ Legal name or Citizenship (Submit copy of ID page of Passport)
SECTION D: Financial Information
Submit financial documents less than 12 months old to verify funds for the next academic year or length of program, if
shorter. The amount of funding required varies by program. For program costs please see:
https://www.du.edu/financialaid/resources/coa.html
Source of funds (check all that apply)
☐
Personal Funds
$
☐
University of Denver
Name of Department/Unit:
$
☐
Non-DU Scholarship
Name of Sponsoring Agency:
$
☐
Family/Private Sponsor*
Name of Sponsor:
$
☐
Family/Private Sponsor*
Name of Sponsor:
$
* If you have funding other than personal funds, please have the person providing the funding sign the following statement
and provide the funding documents as described above or supply a financial guarantee letter from your financial sponsor.
Statement of Guaranteed Funding
I, __________________________________, certify that funding in the amount(s) indicated above will be available to support
the student named in Part A during his/her program at the University of Denver.
Signature of Sponsor _________________________________________ Date _______________
SECTION E: Dependent Information
If your dependents (spouse and/or unmarried children under 21 years old) will come to the U.S. in F-2 or J-2 status, you must
provide evidence of sufficient financial support prior to the issuance of Form I-20/Form DS-2019 ($5,200 per academic year
for a spouse and $3,960 for a child). Please submit copies of dependents’ passport ID pages.
Spouse
Child 1
Child 2
Child 3
Family Name from passport
First Name from passport
Middle Name from passport
Date of Birth (mm/dd/yyyy)
City and Country of Birth
Country of Citizenship
Country of Legal Residence
☐ Female ☐ Male
☐ Female ☐ Male
☐ Female ☐ Male
☐ Female ☐ Male
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Completed 29 August 2020

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