Applicant’s Information (PLEASE PRINT CLEARLY):
Family/Last Name _________________________________________
First Name _________________________________________
Middle Name _________________________________________
Date of Birth __________/_______/_____________
Month Day Year
Gender (Male/Female) _______________________________
Country of Birth _______________________________
Country of Citizenship______________________________
I will be applying for F1 (check one): in my home country_________ in the U.S.____________
*If applying in the U.S. (changing status): my current visa is: ______ and my I-94 expires on___________
I will be transferring from: _________________________________ on (date) ______________
Home Country Address (Foreign): ________________________________________________
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
Semester I am applying for: Spring _____Summer_____ Fall _____Year________
* If applying abroad: The earliest time I will be available to come to the United States is:
Month Day Year
My major/program of study will be (not ESL):________________________________
I am English proficient: Yes________ No (will need ESL classes) ________
My expenses will be covered as follows:
My (applicant’s) 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)
When my I-20 form is ready:
_____ Call/Email me at (phone number/email address): ____________________________________
_____ Call the following person: ____________________________at ________________________
_____ Mail it to this address (only if applying abroad): ____________________________________
I have checked and confirm that all of the information I have provided on this form is correct:
_______________________________________________ __________________
Applicant’s Signature Today’s Date
The best phone number to reach me is: (_________) ____________________________
My email address is: _______________________________________________________
___This I-20 Request Form (completed in its entirety)
___Affidavit of Free Room and Board (notarized and with proof of address)
___Affidavit of Support (with applicable financial documents)
___Personal bank statement (only if applicable)
___Passport copy
Please submit COPIES of the above documents and keep originals for the U.S. Embassy or USCIS (if you are changing
your status in the U.S. to file with I-539).
click to sign
click to edit