Application For The Certificate Of Eligibility Form I20 Or Ds2019

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Application for the Certificate of Eligibility (Form I-20) or (DS-2019)
For Degree Students
International students who are admitted into a degree program at CSI/CUNY will need to obtain a Certificate of Eligibility (Form I-20) or (DS-2019), in
order to enter and/or remain in the U.S. as an F-1 or J-1 student. This requirement applies whether you are a new student, a transfer student from another
U.S. university, or a student transferring between CUNY colleges.
(Please print clearly)
Sex (check one) ⃞ Male ⃞Female
(Family name as in passport) (Given name as in passport) (Second given, or middle name, if any, as in passport)
2. Present Mailing Address _________________________________________________________________________________
(Number and street) (City, State) (Country) (postal code)
3. Telephone Number__________________________________
E-Mail _________________________________________
4. Date of Birth_____________________________________
City of Birth _____________________________________
5. Country(ies) of Citizenship_______________________________ Country of Residence ______________________________
6. Permanent Overseas Address ______________________________________________________________________________
(Required by U.S. Government Regulations) (Number and street) (City, State) (Country) (postal code)
7. Address in U.S.A. (if known) _____________________________________________________________________________
(Number and street) (City) (State) (Zip code)
8. Expected Semester of Enrollment:
Fall 20 ________ Spring 20 ___________
9. Degree Program & Academic Major ________________________________________________________________________
10. Are you currently studying at a U.S. institution or college? _____________________________________________________
11. Do you currently hold F-1/J-1 status? ______________________________________________________________________
If you are currently in the U.S., please indicate your immigration status. Attach a copy of the passport pages with the passport number, expiration date of
passport, and the U.S. visa stamp. Include copies of both sides of Form I-94 for yourself and accompanying family members.
12. Immigration Status__________
I-94 Admission#_______________ I-94 Expires On___________________
(Attach copies of ALL your previously issued Forms I-20 or DS-2019)
13. University that issued most recent Form I-20 SEVIS # N ____________________________________________
14. Current U.S. school: Name: ___________________________________________________________________
Address: _____________________________________________________________________________________
(Number and street) (City) (State) (Zip code)
The Center, 06/14


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