Montgomery College
International Student Office
I-20 REQUEST FORM - SUPPLEMENTAL INFORMATION
Please answer all applicable questions on this form or there may be delays for your I-20 or registration.
Section I - ALL applicants complete this section. USE THE NAME ON YOUR PASSPORT ON THIS FORM.
* Submit a copy of the passport page that contains your names.
________________________________________________________________________________________________________________________
Last Name / Surname(s) First / Given Name(s) MC I.D. Number (If known)
________________________________________________________________________________________________________________________
Phones – home country and US. Please include all digits Student’s e-mail address
________________________________________________________________________________________________________________________
U.S. Local Address (Street number / City / State) Date of Birth (mm/dd/yy)
_______________________________________________________________________________ Gender: ☐ Male ☐ Female ☐ Other
Montgomery College Major
Local Contact Person: __________________________________________________________________________________________________
Name / Relationship / Telephone Number / Email
The person listed as my Local Contact Person may (check all that apply)*:
☐ See my file contents, ☐ Receive my documents, ☐ I do not want my contact to have access to my file.
(to change the person or access – the student must send a signed letter or email from their personal email address)
Sponsor´s Information
________________________________________________________________________________________________________________________
Name Telephone Number Email
Mailing Address In Your Home Country ( REQUIRED INFORMATION - P.O. Box is allowed for this address)
________________________________________________________________________________________________________________________
House number and street OR P.O. Box number City
________________________________________________________________________________________________________________________
State, Province, or District the City is in. Country Postal Code – if available
Do you have any family members who will need a student dependent “F2” Status? : ☐ Yes ☐ No
Section II - Complete this area ONLY if you are currently in the United States. (Complete 1 OR 2)
1. Current Student - Please submit a legible copy of your current I-20 (all pages), I-94 card (front and back), visa, passport ID
page, & Employment Authorization Card (if applicable).
________________________________________________________________________________________________________________________
Name of your U.S. School Dates of Attendance: Start of studies Last day of classes or I-20
2. Non F-1 - Visa type Letter and Number _______________________________ Date status expires _______________________________
PLEASE CHOOSE: ☐ I will travel outside of the US and apply for an F-1 Student Visa overseas
☐ I wish to apply for a Change of Status (appointment with Coordinator required)
___________________________________________________ Month ________________ Day ________________ , Year 20 ______ .
Applicant’s Signature
*Due to Federal Regulations (FERPA): To allow any “Third Party” (anyone other than the student or the College) to see the student’s file
information– THE STUDENT MUST NOTIFY THE INTERNATIONAL OFFICE BY COMPLETING AND SIGNING THIS FORM. 02/19.
