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Student ID: ___________ STUDENT INFORMATION SHEET ADMITTED INTERNATIONAL UNDERGRADUATE STUDENTS International students admitted to the University of California, Santa Cruz that have accepted their offer of admission and are seeking to enter the U.S. in F-‐1 or J-‐1 status must obtain an I-‐20 (Certificate of Eligibility for Nonimmigrant F-‐1 Student) or a DS-‐2019 (Certificate of Eligibility for Exchange Visitor J-‐1 Status). A valid Form I-‐20 or DS-‐2019 is required to apply for the F-‐1 or J-‐1 visa. Complete the following form to obtain an F-‐1 I-‐20 or a J-‐1 DS-‐2019. F-‐1 status is the more common status requested by students. J-‐1 status is used primarily by students in specific exchange programs, such as Fulbright, but may be requested by degree-‐seeking students. For an F-‐1 vs. J-‐1 comparison, please visit http://ieo.ucsc.edu/intl-‐students/new/f1vsj1.html. I will apply for a: o F-‐1 visa o J-‐1 visa Academic Level: o Freshman o Junior Transfer I will begin my program in: o Summer Academy: International (07/27/15) (select one) o Fall 2015 (Quarter begins 09/19/15)* Deadline: May 15, 2015 Deadline: July 1, 2015 *Freshmen must arrive by 09/08/15 for mandatory International Orientation
Are You Currently In The U.S.? o Yes o No If Yes, what is your current status? o F-‐1 o J-‐1 o Other (Please Specify): . If Yes, will you file a change of status petition within the U.S. to become F-‐1 or J-‐1? o Yes o No Did you attend a U.S. school/university within the last 5 months? o Yes o No If Yes, please complete the Transfer-‐In Verification Form at http://ieo.ucsc.edu/intl-‐students/forms/new.html Name of School: Date of last attendance (mm/dd/yyyy): . SECTION A. STUDENT INFORMATION. Please type. Upload copy of passport identity/biographical page. Surname/Family Name(s): Given/First Name(s): Date of Birth (mm/dd/yyyy): Gender: o Female o Male Country of Citizenship: Country of Birth: Place of Birth: Current Occupation (for J-‐1 only): Country of Legal Permanent Residence (for J-‐1 only): SECTION B. DEPENDENT INFORMATION. Complete this section only if you are requesting an I-‐20/DS-‐2019 for your dependents (spouse or unmarried child under 21 years old). Please type. Upload a copy of the dependent’s passport identity/biographical page. Family Name ISSS, UC Santa Cruz Given Name Date of Birth Place of Birth 1156 High Street, Classroom Unit Building, Room 101, Santa Cruz, CA 95064 Relationship istudent@ucsc.edu 1 Student ID: ___________ SECTION C. ADDRESS INFORMATION. Please type. Street Address: Permanent Address in Home Country (complete all fields) City: Province: Country: Postal Code: Email: Street Address: Current Local Address, if in the U.S. (complete all fields) City: State: Zip Code: U.S. Email: U.S. Phone Number: SECTION D. HOW DO YOU WANT TO RECEIVE YOUR I-‐20 OR DS-‐2019? Please type. Choose only one. o Option 1: eShipGlobal Delivery in 3-‐4 days Express mail via FedEx, DHL, or UPS. Create student account online at https://study.eshipglobal.com/. Select a mail carrier and enter credit card payment to create the shipping label. ISSS will be automatically notified when your label has been created and will mail your documents. Please note you must use eShipGlobal to track your package; it will not appear if you try to use the carriers’ websites. *Iranian students: eShipGlobal does not currently serve Iran. If you
are in Iran and choose Option 1, we recommend using an address for someone outside Iran that you know can get your documents to you. o Option 2: U.S. Domestic Mail*, write in address Street Address: (Delivery in 3-‐7 days) *U.S. addresses only
o Option 3: International Airmail, write in address (Delivery in 4-6 weeks) City State: Country: Postal Code: o Option 4: Pick-‐up in person. The person named here will pick up my I-‐20/DS-‐2019 at the ISSS office: Name: ______________________________________ Phone/Email: _________________________ ISSS, UC Santa Cruz 1156 High Street, Classroom Unit Building, Room 101, Santa Cruz, CA 95064 istudent@ucsc.edu 2