F-1 Visa Student request for Form I-20 Please complete all applicable fields. You must attach all required immigration documents (financial documents, copy of passport, etc.) to this form and submit them to the Registrar’s Office. Should you wish to complete a paper form, please download the form here, and submit it via mail to Chowan University, Registrar’s Office, One University Place, Murfreesboro, NC 27855, by fax at (252)398-6443, or by email Registrar@chowan.edu Purpose Purpose * Initial I-20 Transfer from U.S. School Reinstatement Reprint Change of Status Reprint Reason Current visa type Applicant Information Please write your name as it appears on your passport. Last Name * First (Given) Name * Middle Name * Chowan ID Number Date of Birth (MM/DD/YYYY) * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 E-mail Address * Gender * Male Female Country of Birth * Country of Citizenship * Start Term * Fall Spring Summer Major/Program Area * Copy of Passport * Files must be less than 2 MB.Allowed file types: gif jpg jpeg png pdf doc. Transfer Information Required if transferring from another educational institution in the United States. Transferring from SEVIS N# Foreign Address Complete physical home address in your home country is required. No P.O. boxes accepted. Street Address * City * Province/Territory * Postal Code Country * Local US AddressOnly for individuals currently residing in the United States. Street Address City State Zip Code County Phone Number Dependents Students with dependents must complete the below section. Dependent is defined as spouse or unmarried child under the age of 21. Financial support of an additional $3000 per dependent must be included in financial documentation. Please list all dependents who will be accompanying you to live in the U.S. during your studies. Only your legal spouse and dependent unmarried children under the age of 21 can be claimed as dependents. The financial requirement for each dependent is an additional U.S. $3,000. A copy of each passport must also be submitted to ISC for issuance of the dependent I-20. Dependent 1 Relationship to Student Family Name (Last Name) First Name (Given Name) Middle Name Date of Birth (MM/DD/YYYY) Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Gender Male Female Country of Birth Country of Citizenship Street Address City Postal Code Province/Territory Country Dependent 2 Relationship to Student Family Name (Last Name) First Name (Given Name) Middle Name Date of Birth (MM/DD/YYYY) Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Gender Male Female Country of Birth Country of Citizenship Street Address City Postal Code Province/Territory Country Dependent 3 Relationship to Student Family Name (Last Name) First Name (Given Name) Middle Name Date of Birth (MM/DD/YYYY) Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Gender Male Female Country of Birth Country of Citizenship Street Address City Postal Code Province/Territory Country Dependent 4 Relationship to Student Family Name (Last Name) First Name (Given Name) Middle Name Date of Birth (MM/DD/YYYY) Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Gender Male Female Country of Birth Country of Citizenship Street Address City Postal Code Province/Territory Country Additional Documentation You must attach all required immigration documents (financial documents, copy of passport, etc.) to this form. Should you need to submit more than the allotted submissions, please email the supporting documents to Registrar@chowan.edu. Documentation 1 Files must be less than 2 MB.Allowed file types: gif jpg jpeg png pdf doc docx. Documentation 2 Files must be less than 2 MB.Allowed file types: gif jpg jpeg png pdf doc docx. Documentation 3 Files must be less than 2 MB.Allowed file types: gif jpg jpeg png pdf doc docx. Student Agreement * I agree I disagree I authorize Chowan University’s Registrar’s Office to access my I-94 arrival and departure date records (accessible through U.S. Customs and Border Protection website) for immigration and on campus employment purposes. Student Electronic Signature * By typing my full name, I hereby agree that the above information is correct to the best of my knowledge.
