International Services Office
Student Personal Data Form
Document Processing Appointment Date ___/___/___ Time ____________
Personal Data
Name: ____________________________________
U.S. Address: ______________________________
U.S. Phone: ________________________________
Email: ____________________________________
Date of Birth: ______________________________
Emergency Contact: __________________________________
Address: ____________________________________________
Phone: ______________________________________________
Your Nation of Birth: ________________________ Your Country of Citizenship: ____________________________________
1. We must see your original documents (I-20/DS-2019, Passport, I-94 record, Proof of Insurance) for processing and
photocopying during document processing appointment.
2. Sign and date your I-20/DS-2019 form at the bottom of page 1, if not already completed
3. Complete “Orientation Evaluation” and submit at your document processing appointment.
4. If you are transferring to FGCU from another U.S. school provide name of school:_____________________________
*******************************For Office Use Only*************************************
1. Current I-20/DS-2019 _____ _____
Review and Process _____
DSO/RO signature and date _____
Student signature and date _____
2. Current Passport _____
Photo Page _____
Visa Page _____
3. I-94 Card/Record
Current entry/visa stamp _____ _____
4. Other Immigration Documents _____ _____
5. Proof of Health Insurance _____ _____
Personal Insurance Waiver (effect. Dates _________to___________)
FGCU Policy (effect. Dates _________to___________)
6. Class Schedule for This Semester _____ _____
# of credit hours enrolled _____
7. US SS# or ITIN# Documents: _______________ ______ ______
8. FNIF Form: Completed: _____
Your signature confirms you have attended the International Student Orientation, received immigration regulation information and provided the
items listed above and believe them to be current and accurate.
_________________________________ _____________ ______________________________ ____________
Student’s Signature Date ISO Staff Signature Date
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