F1 Eligiblity (SEVIS Form I-20)Application

F1 Visa Certificate of Eligibility (SEVIS I-20) Application Form

Your Name

First NameLast Name

Middle Name

Birth City

Birth Country

Country of Permanent Legal Residence

Foreign Address PO Box not acceptable

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Foreign Cell Number

Email Address

U.S.. Address PO Box not acceptable

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Will student receive a stipend/scholarship from Temple College? Yes/No

If yes from what department

Amount of scholarship $$

If a student is not receiving a stipend/scholarship from TC, how will he/she support him/herself? Personal funds, Government funds, other parents sponsor/friend proof of funding must be provided. Note: the minimum amount of funding must total 16,724 for tuition and living expenses for an F-1 student. (Funding amount required could change each year)

List the names, relationships, citizenships, birthdates, and birthplaces of ALL dependent family

Members (Spouse and unmarried children under the age of 21 only) who will accompany the student

Note: The minimum amount of funding required per dependent is $3,600. Correct spelling is EXTREMELY important; names should appear as on passport. Please provide a copy of passport name page for each dependent.

Name of any dependents and birth city and birth country

Sponsoring Department or person for scholarship for funding support

Name and Title of Department Contact

Configurable list

Phone Number

Email

Projected Program State Date with Temple College (mm/dd/yyyy)

Date

MonthDayYear

Complete only if in U.S.

Current Visa Status

U.S. Phone Number

If Yes Current College/University

Current International Advisor Name

Current International Advisor Cell Phone Number

Email for Current Advisor

SEVIS Number

I94 Number

I-20 valid from: (mm/dd/yyyy) To (mm/dd/yyyy) and upload a copy of form I-20

Date

MonthDayYear

Date

MonthDayYear

If student is on OPT (Must attach copy of EAD card)

Starting OPT Date:

MonthDayYear

Ending OPT Date:

MonthDayYear

Employer Name:

Employer Contact Person

Employer Phone Number

File Upload

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