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Today's date: ______________
Name _______________ ________
_________________________________
Is your name correctly presented on the most recent I-20?
____Yes ____No
Does your name match the name of your I-94 card, your visa,
and your passport?
Please check carefully. ____Yes ____No
Local Address (must be house address or dorm box number
for immigration purposes)
_______________________________________________________________________
Home Address
Telephone ______________ Email _______________ Date of Birth
________ (m/d/yr)
Country of Birth______________ Country of Citizenship ________________________
Current Major _____________________ Current Minor________________________
Is major different from major shown on most recent I-20?
____Yes ____ No
Expected Completion Date ___________________________
Is current expected completion date different from date on
I-20? ___________
Do you plan to travel outside the United States during the
next break? Yes ___ No ___
If yes, will you be applying for a new visa? Yes ___ No___
Are you currently out of status and needing to apply for
reinstatement? ___Yes ___No
Will you need to apply for an extension of studies before
the end of the current semester? ___Yes ___No
If your completion date is this semester, will you be (1)
returning home ___ (2) applying for OPT ___ (3) transferring
schools for additional studies ___ (4) other ____
If other, please explain:_________________________________________________
Please attach copies of (1) most current I-20 and (2) any
past I-20's issued
NOTE: STUDENTS REQUESTING NEW I-20's ARE
REQUIRED TO SHOW FINANCIAL PROOF OF ABILITY TO PAY FOR THE
NEXT TWO ACADEMIC SEMESTERS.
Note: Sample document DO NOT
print.
For Word document click
here.
International Student
Services WVU Tech.
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