ࡱ> c Wbjbj .nQbQb 44444HHHH ,H'8H[td3 %%%%%%%$(*T &4 [[ &44&2%%%%%% .44%%% %%%%%%%nw;!:%%%&<'%% +O! +%% +4%% %% & &%% ' + B :   International Student Services SEVIS INFORMATION FORM Rev. 05/19 To be completed by all applicants for the purpose of generating a Form I-20. Name:  FORMTEXT        FORMTEXT       Exactly as it appears in passport (Last/ Family Name/ Surname) (First/ Given Name) City of Birth:  FORMTEXT       Country of Birth:  FORMTEXT       Country of Citizenship:  FORMTEXT       Country of Permanent Residence:  FORMTEXT       Date of Birth: (mm/dd/yy) FORMTEXT       Gender:  FORMCHECKBOX  MALE  FORMCHECKBOX  FEMALE Education level to be pursued at NSU:  FORMCHECKBOX  ASSOCIATE S  FORMCHECKBOX BACHELOR S  FORMCHECKBOX  MASTER S  FORMCHECKBOX  DOCTORATE Major to be pursued at NSU:  FORMTEXT       Visa status you are seeking:  FORMCHECKBOX  F-1  FORMCHECKBOX  J-1  FORMCHECKBOX  Other Visa status if currently in United States  FORMTEXT       Do you need to apply for a change of visa status? If yes, please print visa types below: I plan to apply for a change of visa status from  FORMTEXT       to  FORMTEXT        FORMCHECKBOX  within the U.S.  FORMCHECKBOX  in my home country. Have you previously attended Norfolk State University?  FORMCHECKBOX  YES  FORMCHECKBOX  NO If yes, when?  FORMTEXT       If you already reside in the United States, please print your date of entry:  FORMTEXT       Have you attended another academic program in F-1 or J-1 status during the five months preceding your desired start date at ɫֱ?  FORMCHECKBOX  YES  FORMCHECKBOX  NO If YES, you must have your present International Student advisor complete and submit a Transfer Eligibility Certificate to the Office of International Student and Scholar Services. Please also complete the following: Current SEVIS ID FORMTEXT       Name of school  FORMTEXT       Designated School Official Name & Phone Number:  FORMTEXT       Did you complete the program at your former school?  FORMCHECKBOX  YES  FORMCHECKBOX  NO Are you currently living outside the United States?  FORMCHECKBOX  YES  FORMCHECKBOX  NO Are you currently engaged in optional practical training?  FORMCHECKBOX  YES  FORMCHECKBOX  NO If yes, please give dates:  FORMTEXT       Email Address (very important for communication purposes):  FORMTEXT       Telephone number(s):  FORMTEXT       Permanent Address Outside U.S. (Department of Homeland Security and SEVIS require a foreign (non-U.S.) permanent address for the issuance of I-20s. P.O. boxes are not acceptable.)  FORMTEXT        FORMTEXT       Address to which you would like I-20 mailed (if different from above):  FORMTEXT        FORMTEXT       U.S. Address (if any):  FORMTEXT        FORMTEXT       Financial Support  FORMCHECKBOX  I will be providing personal funds for all or part of my education at Norfolk State University. 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Amount of support from personal funds: $ FORMTEXT        FORMCHECKBOX  Financial support will come from an individual sponsor, government sponsor, scholarship, assistantship, fellowship, or other type of support. (Submit original bank statements and Affidavits of Support, government sponsorship letter, scholarship/assistantship award letter, and/or other proof.) Housing Information:  FORMCHECKBOX  I plan to obtain on-campus housing. I will pay the $300 deposit before the deadline.  FORMCHECKBOX  The housing deposit deadline has passed but I would like to obtain on-campus housing. I will pay the $300 deposit after the deadline and contact the Office of Residential Life to see if space is available. I am aware that on-campus housing is limited and I cannot be guaranteed a room in a residence hall. I have alternative plans should I need to find a room or apartment off-campus.  FORMCHECKBOX  I have plans to live off-campus. Dependent Information:  FORMCHECKBOX  I have dependents who will accompany me to the United States (e.g. spouse/ children under the age of 21). Please complete for each dependent: Name:  FORMTEXT       Relationship:  FORMTEXT       Date of Birth:  FORMTEXT       City of Birth:  FORMTEXT       Country of Birth:  FORMTEXT       Country of Citizenship:  FORMTEXT       Country of Permanent Residence:  FORMTEXT       Name:  FORMTEXT       Relationship:  FORMTEXT       Date of Birth:  FORMTEXT       City of Birth:  FORMTEXT       Country of Birth:  FORMTEXT       Country of Citizenship:  FORMTEXT       Country of Permanent Residence:  FORMTEXT        FORMCHECKBOX  Check here if you have more than two dependents and provide information on an additional sheet of paper. I CERTIFY THAT THE INFORMATION GIVEN ON THIS FORM IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I understand that if my sponsors fail to provide the funds indicated on the affidavit of support, the University is under no obligation to support me and it is likely that I will be unable to continue my education at Norfolk State University. 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