DEPENDENT INFORMATION FORM
SEAVER
LAW
GSBM GSEP SPP
Office of International Student Services (OISS) ▪ Phone: +1 310-506-4246 ▪ E-mail: oiss@pepperdine.edu
Revised on 11/27/2017
Received by:
Signed by: on line. Date:
Date: New I-20 issued for:
Dependent's Last Name
Dependent's First Name
Dependent's Middle Name
Dependent's Gender
Your Relationship to Dependent
Dependent's Date of Birth
Dependent's Email Addr
ess
I have attached updated financial documentation from within the past twelve months. I understand that the
dependent costs, estimated at U.S. $500 per month for each dependent, will be added to
my Form I-20.
I have attached a passport identity page and evidence of the familial relationship to the person(s) for whom I am
submitted this request.
To request a Form I-20 (for F-2 dependent visa status) for your spouse or unmarried child under the age of 21, submit
this form along with the required documentation listed below.
Your F-2 dependent(s) must obtain a travel endorsement signature on page 2 of their Form I-20 prior to temporarily
departing the U.S. while you are in F-1 status.
After completing this form, save it as a pdf and email the pdf to oiss@pepperidne.edu
Read the following statements and check each box.
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Dependent's Country of Birth
Dependent's Country of
Citizenship
Dependent's Country of Permanent Residence
____ / ____/ ____
Month Day Year
Submit this Form and proper documentation to oiss@pepperdine.edu
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