I-20 Extension Request Form
I would like to request an extension of my I-20 for the period of ________________semester (s)
When I began my studies at Norwalk Community College, my English level was ____________.
Family (Last) Name _________________________________________
First Name _________________________________________
Middle Name _________________________________________
Date of Birth __________/_______/_____________
Month Day Year
Gender (Male/Female)______________________________
Country of Birth _______________________________
Country of Citizenship______________________________
Foreign Address: ______________________________________________________________
Street name and number, apt. number if applicable
City Province/Territory Postal Code Country
U.S. Address (where you will reside while attending NCC):
Street name and number, apt. number if applicable
City State Zip Code
My expenses will be covered as follows:
I have personal funds in the amount of: $________________ (see attached bank letter), which I intend to
use to cover school tuition____, living expenses____ (check all that apply).
Room and board will be provided by: _________________________________________ (see attached letter of residence)
Sponsor: ____________________________________ (see attached form I-134 and appropriate financial documents)
My current English/ESL level is: _______________________
My major (program of study) is: ______________________________________
I have checked and confirm that all of the information I have provided in this form is correct:
_______________________________________________ __________________
Applicant’s Signature Today’s Date
The best phone number to reach me is: (_________) ____________________________
My email address is: _______________________________________________________
When my I-20 form is ready:
_____ Call/Email me at (phone number/email address): ____________________________________
_____ Mail it to the following address: __________________________________________________