Full-Time International Student Data Sheet
Please complete this form very carefully as information provided is used on the I-20
Print and complete your name exactly as it appears on your passport.
LAST (FAMILY) NAME ____________________________________________________________________
GIVEN NAMES ___________________________________________________________________________
HOME COUNTRY MAILING ADDRESS
STREET AND NUMBER ________________________________________________________________________________________
CITY ___________________________________________ PROVINCE/TERRITORY ____________________________________
COUNTRY ______________________________________ POSTAL CODE ____________________________________________
COUNTRY OF BIRTH _______________________________________________________________________________________________
COUNTRY OF CITIZENSHIP _________________________________________________________________________________________
CITY OF BIRTH ____________________________________________________________________________________________________
DATE OF BIRTH: MONTH ______________ DAY ________ YEAR ___________
MY NATIVE LANGUAGE IS __________________________________________________________________________________________
IMMIGRATION STATUS: (Visa) _____________________________________________________________________________________
SEMESTER START DATE (check only one)
FALL SEMESTER (August to December) SPRING SEMESTER (January to May) SUMMER SEMESTER (May to August)
YEAR ____________
YOUR INTENDED PROGRAM OF STUDY/MAJOR _____________________________________________________________________
EMAIL ADDRESS ___________________________________________________________________________________________________
CELL/MOBILE _____________________________________________________________________________________________________
WILL ANY DEPENDENTS BE LIVING WITH YOU IN THE UNITED STATES? YES NO
PLEASE SUBMIT A SEPARATE DEPENDENT DATA SHEET/PASSPORT COPY /VISA COPY and FINANCIAL CERTIFICATION
FOR EACH OF YOUR DEPENDENTS.
PAYMENT METHOD (Please select one)
Self
Scholarship. If yes, please provide name _______________________________________________________________________
Other
r. 6/2020