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admissions@academycollege.edu
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Request Info
I-20 REQUEST FORM
A) I-20 REQUEST TYPE
Request Type
New F-1 status (outside the United States)
Change of status to F-1 from (current status)
Other status
B) STATUS INFORMATION
Family Name (Surname):
First Name (Given):
Middle Name:
Country of Birth:
Country of Citizenship:
Date of Birth (mm/dd/yyyy):
MM slash DD slash YYYY
Gender:
Male
Female
Email Address:
Copy of Passport Photo Page:
Already sent
Attached
Will be sent
If applicable, please list your spouse and/or child as an F-2 dependent:
Name
First
Last
Date
MM slash DD slash YYYY
Country of Birth
Relationship to Student
Intended Semester/Session Start:
Fall
Spring
Summer
Winter
Year:
Degree Program:
Permanent Residential Address in Your Home Country
Street and Number:
City:
Province/State:
Postal Code:
Country:
Telephone Country Code:
City Code:
Telephone Number:
C) FINANCIAL SUPPORT
Students who wish to study in the United States in F-1 status must have the ability to afford all educational and living expenses while enrolled in their program. Available liquid assets to cover these expenses must be demonstrated. Students may be sponsored by a parent, relative, friend, government agency, scholarship agency or themselves. An original copy of the student’s current bank statement and/or from their sponsor(s) must be provided to validate certification noted on the form.
Source of Funds (mark all that apply)
Personal funds/self supporting
Parents/family – Relationship:
Your Government – Name:
Scholarship
Sponsor Support – Name:
Supporting Documents Required
Certified Bank Statement
Signed copy of Award Letter
Signed copy & details of award
Bank statement and Affidavit of Support and Supporting evident (Form I-134 on www.uscis.gov)
Amount in US Dollars
Certified Bank Statement
Signed copy of Award Letter
Signed copy & details of award
Bank statement and Affidavit of Support and Supporting evident (Form I-134 on www.uscis.gov)
TOTAL FUNDS:
D) ARE YOU CURRENTLY LIVING IN THE UNITED STATES?
D) ARE YOU CURRENTLY LIVING IN THE UNITED STATES?
No (skip to section F)
Yes (fill out the information below)
U.S. Street Address:
City:
State:
Zip code:
Telephone Number:
Admission Number
Please submit the following required documents:
Copy of Passport Visa Page:
Already sent
Attached
Will be sent
Copy of I-94:
Already sent
Attached
Will be sent
E) SCHOOL TRANSFER
If you are not transferring schools, skip to section F.
School where you were last authorized to attend by the Department of Homeland Security:
School:
City:
State:
Date
MM slash DD slash YYYY
Copy of previous I-20 Form(s):
Attached
Will be sent
F) REFERENCE
How did you learn about Academy College?
G) SIGNATURE
I certify that all information provided is complete to the best of my knowledge.
Signature
Date
MM slash DD slash YYYY
Return this form to the Admissions Office:
By email (preferred)
By fax
By mail
Scan/attach documents and email admissions@academycollege.edu
ATTN: Admissions Department 952.851.0094
Academy College 1600 W 82 nd St. Suite 100 Bloomington, MN 55431 U.S.A.
H) If I attend Academy College, I understand the following:
I must maintain my status with respect to the United States Citizenship and Immigration Services (USCIS) regulations for the duration of my studies at Academy College. This includes but is not limited to: o Enrolling as a full-time student (12 credits) each quarter o Obtaining proper authorization before making any schedule change which would result in taking less than 12 credits per quarter o Accepting employment only when proper authorization has been obtained from a designated school official at Academy College and USCIS o Maintaining a valid passport and US visa at all times o Making timely payment of all tuition and fees owed to Academy College • I must have adequate funds to meet all my expenses during my studies at Academy College. I understand that I may be required to make an advance deposit for all or part of the first year’s educational expenses in order to receive an I-20. I further understand that failure to meet financial obligations to Academy College may result in a cancellation of my Academy College I-20. • I must abide by Academy College policies and procedures as they apply to student conduct and academic progress. Policies are explained in the Academy College catalog.
Signature
Date
MM slash DD slash YYYY
