Fillable Dependent Infomation Form - Dependent Information for Exchange Visitors

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Dependent Infomation Form - Dependent Information for Exchange Visitors

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The Dependent Infomation Form - Dependent Information for Exchange Visitors form is 2 pages long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for Wichita State University

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IMPORTANT :*
1)!!Names!should!be!written!as!they!are!listed!in!th e ir! passports.!
2)!!List!only!those!who!will!be!coming!to!the!U.S.!on!a!J>2!visa.!
3)!!Dependent!children!must!be!under!the!age!of!21.!
4)!!The!Exchange!Visitor!must!provide!evidence!of!financial!support!for!the!spouse!and!all!dependent!children!
!!!!!!in!the!amount!o f!$ 400!per!month!for!each!for!the!entire!length!of!the!program.!
5)!!Medical!insurance!coverage!must!be!maintained!for!the!spouse!and!all!dependent!children!
!!!!!during!the!entire!program.!
6)!!After!completing!this!form,!return!it!with!passport!copies!of!your!spouse!and!all!dependents!to!Ms.!Julie!!
!!!!!Christensson!at!julie.christensson@wichita.edu.!
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______________________________________!!____________________________!!________________________!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Last!Name!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!First!Name!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Middle!Name!
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______________________________________!!____________________________!!________________________!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Last!Name!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!First!Name!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Middle!Name!
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Relationship:!!!!!!!!!!!!Husband!!!!!!!!!!!!!Wife!!!!!!!!!!!Date!of!Birth!(mm/dd/yyyy):!!_____________________________!!!!!
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Place!of!Birth:!!___________________________________!!!____________________________________!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!City!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Country!
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Country!of!Citizenship:!!_________________________!Country!of!Legal!Permanent!Residence:!!_______________________!
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Dependent*Information*
Form*
Exchange*Visitor*Information*
Information*fo r*S p o u se *
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______________________________________!!____________________________!!________________________!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Last!Name!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!First!Name!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Middle!Name!
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Relationship:!!!!!!!!!!!!Son!!!!!!!!!!!!Daughter!!!!!!!!!!!Date!of!Birth!(mm/dd/yyyy):!!_____________________________!!!!!
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Place!of!Birth:!!___________________________________!!!____________________________________!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!City!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Country!
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Country!of!Citizenship:!!_________________________!Country!of!Legal!Permanent!Residence:!!_______________________!
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______________________________________!!____________________________!!________________________!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Last!Name!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!First!Name!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Middle!Name!
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Relationship:!!!!!!!!!!!!Son!!!!!!!!!!!!Daughter!!!!!!!!!!!Date!of!Birth!(mm/dd/yyyy):!!_____________________________!!!!!
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Place!of!Birth:!!___________________________________!!!____________________________________!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!City!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Country!
!
Country!of!Citizenship:!!_________________________!Country!of!Legal!Permanent!Residence:!!_______________________!
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______________________________________!!____________________________!!________________________!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Last!Name!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!First!Name!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Middle!Name!
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Relationship:!!!!!!!!!!!!Son!!!!!!!!!!!!Daughter!!!!!!!!!!!Date!of!Birth!(mm/dd/yyyy):!!_____________________________!!!!!
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Place!of!Birth:!!___________________________________!!!____________________________________!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!City!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Country!
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Country!of!Citizenship:!!_________________________!Country!of!Legal!Permanent!Residence:!!_______________________!
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______________________________________!!____________________________!!________________________!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Last!Name!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!First!Name!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Middle!Name!
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Relationship:!!!!!!!!!!!!Son!!!!!!!!!!!!Daughter!!!!!!!!!!!Date!of!Birth!(mm/dd/yyyy):!!_____________________________!!!!!
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Place!of!Birth:!!___________________________________!!!____________________________________!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!City!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Country!
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Country!of!Citizenship:!!_________________________!Country!of!Legal!Permanent!Residence:!!_______________________!
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If!you!hav e!a d d itio n a l!d e p e n d e n ts,!u s e !a n !ad d it io n al!p ie c e !o f!p a p er .!
Information*fo r*C h ild r e n*
*Child*#1*
*Child*#2*
*Child*#3*
*Child*#4*
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Dependent Infomation Form - Dependent Information for Exchange Visitors

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Completed 3 March 2020

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