________________________________________________________ ____________________________
New I-20 Request Form
Student to complete:
Student Name:
______________________ ______________________ _________
Family Name First Name MI
Date of Birth: ____________
Phone#:
_____________
Email : _______________@go.pasadena.edu
mm/dd/yyyy
PCC ID#: _______________ SEVIS ID#: N00________________
(last 8 digits)
Major: ________________ First semester at PCC: ___________ Expected Graduation: ___________
semester/year semester/year
Program End Date on I-20: _________ Passport Expiration Date: _________ Visa Expiration Date: _________
mm/dd/yyyymm/dd/yyyymm/dd/yyyy
Reason for requesting a new I-20 (select one):
Replacement of I-20 (Check one):
Lost
Stolen
Damaged Legal Name Change (submit a copy of new passport)
Other: ______________ ____________________
Extension of Program (Submit the following): New Program End Date: _____________
mm/dd/yyyy
• Copy of new Educational Plan (from Academic Counselor)
• I-20 Extension Recommendation Form (signed by Academic Counselor)
• Proof of financial support (original bank statement and sponsor affidavit form)
C
hange of Major to
_______ ___________________ (Submit the following):
• Copy of New Educational Plan (from Academic Counselor)
Adding Dependents to I-20 (Submit the following):
• Dependents’ copy of passport, visa, and a copy of I-94 Record (obtain at cbp.gov/i94) (if applicable)
• For each dependent, you must provide additional proof of financial support. ISC has estimated the cost for spouse
to be $5000 and for one child to be $3000. All financial document must be submitted in English.
Regain Legal Status (check one):
Reenter the U.S. with an initial I-20 (submit the following): Date returning to the U.S.: ___________
mm/dd/yyyy
• Only those with a GPA of 2.0 or higher and no other violations will be considered
• Copy of new Educational Plan (from Academic Counselor)
• Proof of financial support (original bank statement and sponsor affidavit form)
Reinstatement within the U.S. (Attach documents detailed in the “Reinstatement Checklist”)
• Copy of new Educational Plan (from Academic Counselor)
• Proof of financial support (original bank statement and sponsor affidavit form)
• Letter of explanation
• All documents in step 3 of the Reinstatement Checklist
I have read and understood the informaon above and my responsibilies. I state that the informaon I provided on this form is true.
Student Signature mm/dd/yyyy
ISC staff to complete:
Unit # _____ SEVIS SARS Request log
Reinstatement only:
Recommendation letter Email student
Initial: ___
___ Date: _________
Important Note: All paperwork requests require 10 business days to process. revised 4/25/2018
