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Student Visa Registration Form

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Student Visa Registration Form

International Programs Office │Ph: 831‐582‐4778 │ Fax: 831‐582‐3314 │

international@csumb.edu

U.S. immigration regulations state all F‐1 and J‐1 students must check‐in with the International Programs

Office. Failure to complete this process may result in the termination of your F‐1/J‐1 status.

PERSONAL INFORMATION

Family Name:__________________________________ First Name (s): __________________________

Date of Birth (mm/dd/yyyy): ______________________ CSUMB Student ID#: ______________________

U.S. Address On Campus: Building/Street: ________________________ Room/Apt.#: _____________

Off Campus: Address Line 1: _________________________________________________

Address Line 2: _________________________________________________

City: ______________________ State:_______ Postal Code:____________

VISA INFORMATION

Visa Type (check one): ☐ F‐1

☐ J‐1

Visa Number: ___________________

Visa Stamp Expiration Date (mm/dd/yyyy): _____________________

IMMIGRATION DOCUMENTS

It is recommended that students keep paper and scanned copies of your travel documents after entry

into the U.S. for safe keeping. These include the I‐20 or DS‐2019, Admission I‐94 Number and Visa

Stamp. We do not keep copies of these documents but may request copies at any given time.

RESPONSIBILITIES ACKNOWLEGEMENT

In order to maintain your status, you must meet the following requirements:

• Full Time Enrollment (Undergrad: 12 units, Graduate: 9 units)

• Valid Passport and current I‐20/DS‐2019

• Participate in authorized work or internship only

• Visit the International Programs Office before Traveling outside the U.S.

By signing this document, I verify that I am aware of the consequences of violating the status of my F-

1 or J-1 visa. I understand that maintaining my student visa status is ultimately my responsibility. I

have been given information and advice about how to maintain valid student visa status and am

aware of the resources available to assist me.

Student Signature:

Date:

Student Visa Registration Form

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