F-1 Student A pplication Supplemental Form
Additional information is needed from students who are applying for F-1 student visa status, to issue an I-20. Please fill
out the form completely. If you have questions contact International Student Services at (+001) 919-536-7264 extension
3228 during office hours (generally Monday Friday 8 a.m. – 5 p.m. US EST) or international@durhamtech.edu.
Please submit this form via mail to Durham Tech International Student Services, 1637 E. Lawson St, Durham, NC 2703 or
upload it electronically through the secure document submission process: durhamtech.edu/how-to-submit-documents-
electronically-cgl.pdf. Please do not submit this form via email.
Durham Tech ID # (If you have one):
Today’s Date:
PASSPORT INFORMATION
Write your names exactly as they appear on your passport
Family Names(s):
Given Names(s):
Middle Names(s):
“Nick Name” or Name(s) you prefer to be called:
Country of Citizenship:
Country of Birth:
City of Birth:
Country of Residence (where you
live):
Email Address:
Will you be requesting F-2 dependent status for your family (spouse or children)? No Yes
ADDRESS IN HOME COUNTRY (NOT THE US) (Street address, not a PO BOX)
Street:
City:
State/Province:
Country:
Postal Code:
ADDRESS WHERE YOU WILL LIVE IN NORTH CAROLINA
Street:
City:
State:
NORTH CAROLINA
Postal Code:
LOCAL CONTACT IN NORTH CAROLINA or the UNITED STATES
Name:
Relationship to you:
Phone Number(s):
Email:
Updated 6/1/2020