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):

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

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)

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?

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

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

Return this form to the Admissions Office:

By email (preferred):
Scan/attach documents and email to:
admissions@academycollege.edu

By fax:
ATTN: Admissions Department
952.851.0094

By mail:
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

A) I-20 REQUEST TYPE

B) STATUS INFORMATION

Permanent Residential Address in Your Home Country

C) FINANCIAL SUPPORT

D) ARE YOU CURRENTLY LIVING IN THE UNITED STATES?

E) SCHOOL TRANSFER

F) REFERENCE

G) SIGNATURE

Return this form to the Admissions Office:

H) If I attend Academy College, I understand the following:

Start your future at Academy College