F-1 Supplemental Application for I-20
This form, along with the other forms and documents required for the I-20, should be mailed or taken to:
Piedmont Virginia Community College
Admissions and Advising Center
501 College Drive
Charlottesville, VA 22902
USA
Personal Information:
Family (Last) Name
Given (First) Name
Middle Name(s)
Date of Birth (Month/Day/Year):
Gender (Male/Female/Not Specified):
Country of Birth:
Country of Citizenship:
Are you currently in the
United States?
Yes
No
If yes, what is your current visa
status?
When does your current status
expire?
Which semester do you want
to begin your studies at
PVCC?
Spring (January)
Application Deadline:
November 1
Fall (August)
Application Deadline:
June 1
Which program of study are you
interested in?
PVCC Student ID Number
(EMPLID #):
Evidence of English Proficiency:
Students applying to PVCC whose first language is NOT ENGLISH must provide evidence of English
proficiency in order to obtain an I-20. (Tests must be within the last two years.)
I have taken one of the tests
listed within the past two
years: (official score report
must be submitted)
TOEFL IBT (61 or higher) (Paper-delivered test: 500+)
IELTS (6 or higher)
SAT: Evidence - Reading and Writing (480 or higher)
ACT: English and Reading (15 or higher on each)
OR
I graduated from a U.S. high
school within the last 5 years
and took English 12 in my
senior year. (official high school
transcript or score report must
be submitted)
High School GPA of 3.0 or higher
High School GPA of 2.7-2.9
Satisfactory score on AP, IB, Cambridge Advanced Level or CLEP
OR
I have studied at a U.S. college
or university whose credits are
accepted by PVCC. (official
college transcript must be
submitted)
Yes, my transcript will show that I passed the equivalent of
ENG 111: College Composition I with a C or better as part of a
full-time course load. (You must have a cumulative GPA of 2.0 or
better to use this option.)
Contact Information:
Permanent Address Outside U.S. (this information is required for the I-20):
Street Address
City
Province
Postal Code
Country
International Phone Number
U.S. Address (if available):
Street Address
City, State, Zip Code
E-mail Address:
Information about Dependents:
Will you be accompanied by
any dependents (can only
include spouse and/or
children)?
No, I plan to come alone.
Yes. (provide information regarding your dependents below,
make additional copies of this page if you have more dependents)
Dependent 1:
Name: (Family, Given, Middle)
Relationship: (Spouse or Child)
Gender: (Male, Female, Not Specified)
Date of Birth: (Month/Day/Year)
Country of Birth:
Country of Citizenship:
Dependent 2:
Name: (Family, Given, Middle)
Relationship: (Spouse or Child)
Gender: (Male, Female, Not Specified)
Date of Birth: (Month/Day/Year)
Country of Birth:
Country of Citizenship:
Indicate which way you
want PVCC to send the
I-20 to you:
Mail the I-20 to the listed U.S. address on this form.
Mail the I-20 to the outside of U.S. address listed on this
form.
Please call the person listed below, whom I authorize
to pick up my I-20.
Name & phone number of
person authorized to pick up
my I-20.
I guarantee that the information provided on this form is correct.
Signature
Date
click to sign
signature
click to edit