Reinstatement To F-1 Status (Page 4 of 4) in pdf

Reinstatement To F-1 Status Page 4

Confirmation of student data for new I-20 form: For student to fill out

Name:_____________________________________________________________________

First name

Middle name

Family name

Student ID number:_______________________

Local address in U.S.:_______________________________________________________________

Street # and Street Name

City

State Zip Code

Home country address:______________________________________________________________

Street # and Name or local part of address

________________________________________________________________________________

City

Province

Postal Code

Country

Do you have dependents in F-2 status? If so, please list:____________________________________

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Confirmation of academic program: For Academic Advisor to fill out

Major:______________________________________________

Degree level:_________________________________________

Anticipated degree completion date:_______________________

Academic Advisor name and signature:________________________________________ Date:___________

Revised: 11/10

Reinstatement To F-1 Status Page 4