I-20 Information Request Form
Please complete this form and submit to the Admissions & Records
Office. All of the fields are required unless otherwise noted.
1.
Current Visa Type
2.
Family/Last Name
3.
First Name
4.
Middle Name
5.
Date of Birth
6.
Gender
7.
Country of Birth
8.
Country of Citizenship
9.
Driver’s License Number and Issuing
State (if applicable)
10.
Social Security Number (if applicable)
11.
Foreign Address
12.
U.S. Address
13.
U.S. Phone Number
14.
Email Address
15.
Program/Major
16.
Amount of Funding Available
for Student (min. $22,113 USD)
17.
Health Insurance Name of
Insurance Company and Expiration
Date