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THIS SECTION TO BE COMPLETED BY THE STUDENT (Michigan State University)

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THIS SECTION TO BE COMPLETED BY THE STUDENT
Last Name:
First Name:
Date of Birth (mm/dd/yyyy):
PID: A
SEVIS ID #: N
Current I-20 or OPT End Date:
REASON FOR REQUESTING I-20
Extension of Program. Must have I-20 Extensions Only: Advisor/Major Professor section completed below.
Change of visa status/obtain F-1 visa stamp. NOTE: You must pay the SEVIS fee (http://fmjfee.com).
Current Visa Status:
Date studies began/will begin:
Replacement of TERMINATED I-20. NOTE: You must pay the SEVIS fee (http://fmjfee.com).
Please indicate when you will leave the U.S. with a new I-20:
Other:
Amounts listed subject to change
Tuition & fees
Living expenses
Insurance
TOTAL
UNDERGRADUATE Fr./Soph.
$40,962
$15,610
$2,172
$58,744
Jr./Sr.
$42,198
$15,610
$2,172
$59,980
MASTERS (does not include MBA)
$25,884
$16,046
$2,172
$44,102
PHD (w/ assistantship)
$25,884
$16,046
$2,172
$44,102
(w/o assistantship)
$17,318
$16,046
$2,172
$35,536
I understand that the cost of tuition and fees may change according to the amount of credits I am taking. I understand that
I must have student health insurance and that, if I have any dependents, then they too must have health insurance.
Student Signature: ______________________________________________________ Date: ________________
I-20 EXTENSIONS ONLY: ACADEMIC ADVISOR/MAJOR PROFESSOR
An F-1 student who is currently maintaining status and making normal progress toward completing his or her
educational objective, but who is unable to complete his or her course of study by the program end date on the Form
I-20, must request an extension of the I-20. Academic advisor must select one of the below reasons for the extension:
Academic
Medical (Student must provide documentations from a medical doctor/psychologist/doctor of osteopathy
documenting the medical condition)
Other:
Expected completion date (month/day/year):
Number of credit remaining:
Name:
Signature:
Phone:
Date:
THIS SECTION TO BE COMPLETED BY OISS
Approved
Denied
OISS Advisor Signature:
Date:
I-20 REQUEST
OFFICE FOR INTERNATIONAL STUDENTS AND SCHOLARS
Phone: 517.353.1720 | Fax: 517.355.4657
E-mail: oiss@msu.edu | Web: www.oiss.msu.edu
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THIS SECTION TO BE COMPLETED BY THE STUDENT (Michigan State University)

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Completed 15 October 2021

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