Application for a Form I-20

International Student Services
3041 Broadway, New York, NY 10027
Phone: 212-280-1396; 212-280-1555

APPLICATION FOR A FORM I-20

Before filling out this form, make sure you have thoroughly read the application handbook and have all documents ready for submission. You will not be able to save your progress on the form and complete it at a later time.

PART I: PERSONAL INFORMATION

1. Name*

First Name

Middle Name

Last Name

Enter your name exactly as shown in your passport. Attach a JPEG or PDF copy of you passport identification page below.

2. Passport Identification Page*

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3. Date of Birth*

Day Month Year

4. Sex/Gender*

Female Male

Please select the sex/gender indicated on your passport. Please select only one for the purposes of this form.

5. Country of Birth*

6. Country of Citizenship*

7. Country of Permanent Residence*

8. Permanent Address in Country of Permanent Residence*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

9. Address in the United States (if known)

Address Line 1

Address Line 2

City

State

ZIP Code

Dependents: A student wishing to have his/her family member(s) accompany him/her must document the following amounts for each family member per calendar year of intended study:

Spouse: $16,380 per calendar year
Each child: $5,232 per calendar year

Please see the Application for a Form I-20 Handbook for further details.

10. Please select one*

I plan to come without dependents. I will be accompanied by dependents

Select the number of dependents coming with you*

1 2 3 4

If you will be accompanied by more than 4 dependents, please contact the office of International Student Affairs.

1. Name of Dependent 1*

First Name

Middle Name

Last Name

Birthday of Dependent 1*

Day Month Year

Country of Birth of Dependent 1*

Country of Citizenship of Dependent 1*

Sex/gender of Dependent 1*

Female Male

Select the sex/gender indicated on the official passport. Please select only one.

Relation of Dependent 1 to you (spouse, child, etc.)*

2. Name of Dependent 2*

First Name

Middle Name

Last Name

Birthday of Dependent 2*

Day Month Year

Country of Birth of Dependent 2*

Country of Citizenship of Dependent 2*

Sex/gender of Dependent 2*

Female Male

Select the sex/gender indicated on the official passport. Please select only one.

Relation of Dependent 2 to you (spouse, child, etc.)*

3. Name of Dependent 3*

First Name

Middle Name

Last Name

Birthday of Dependent 3*

Day Month Year

Country of Birth of Dependent 3*

Country of Citizenship of Dependent 3*

Sex/gender of Dependent 3*

Female Male

Select the sex/gender indicated on the official passport. Please select only one.

Relation of Dependent 3 to you (spouse, child, etc.)*

4. Name of Dependent 4*

First Name

Middle Name

Last Name

Birthday of Dependent 4*

Day Month Year

Country of Birth of Dependent 4*

Country of Citizenship of Dependent 4*

Sex/gender of Dependent 4*

Female Male

Select the sex/gender indicated on the official passport. Please select only one.

Relation of Dependent 4 to you (spouse, child, etc.)*

10. Telephone*

11. Email*

12. Fax

13. Have you been notified of your admission to Union Theological Seminary?*

Yes No

Please note that your Form I-20 cannot be issued until you are accepted.

PART II: IMMIGRATION STATUS

Are you currently in the United States?*

Yes No

What is your Immigration Status?*

F-1 Another Status

Short Answer*

What is your SEVIS ID Number? N_______________

What is the purpose of your requested Form I-20? (choose one)*

Transfer In Change of education level or program at Union Theological Seminary Regain F-1 Status

Do you plan to travel outside the U.S. before school starts*

Yes No

If you are F-1, you will receive "Transfer In" or other instructions. If you hold another status, we must meet with you before issuing your Form I-20.

Did you recently attend school in the U.S. with F-1 status?*

Yes No

If you attended a U.S. school last term and are just home on holiday between academic terms, you are considered a "Transfer In" and need to have your record transferred out to us before your Form I-20 may be issued. Please contact your international student advisor at your previous school immediately to authorize the release of your record to us.

What was the last date of your attendance?*

Day/Month/Year

Part III: RECEIVING THE FORM I-20

How do you prefer to receive your Form I-20?*

Mail Hold for pick up

Name for mailing*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Your Form I-20 will be sent standard airmail to the name you indicate above. If you need express delivery service, you should request someone in the U.S. to pick it up and send it to you. If that is not possible, please contact our office. ENTER YOUR NAME AND ADDRESS IN ENGLISH EXACTLY AS IT SHOULD APPEAR ON THE ENVELOPE.

Hold for pick up by:*

First Name

Last Name

Phone*

Email*

Part IV: STUDENT"S STATEMENT OF FINANCIAL SUPPORT

Do not complete this part unless you have carefully read all the instructions in the Application Handbook!

What level of education will you be pursuing?*

(Master's, Doctorate)

What will you major or concentration area be?*

What are your annual costs from the Workbox on page 5 of the Application Handbook?* $

How will you be funded for every year of your program of study? Please check off your funding below and indicate how much will be provided to you every year:

Sources of financial support*

Personal Funds Funds from Union Theological Seminary Cash Funds from a Sponsor Free Room and Board from a Sponsor On-campus employment

Annual amount available to me from my own resources every year* $

Funds from this school renewable every year as scholarship, grant, fellowship, or loan* $

How many sponsors will you receive cash support from?*

1 2 3

Sponsor 1*

First Name

Last Name

Cash Funds from Sponsor 1 to be given to me every year* $

Sponsor 2*

First Name

Last Name

Cash Funds from Sponsor 2 to be given to me every year* $

Sponsor 3*

First Name

Last Name

Cash Funds from Sponsor 3 to be given to me every year* $

Name of Sponsor providing Free Room and Board*

First Name

Last Name

Free Room and Board from a Sponsor* $

On-Campus Employment* $

Give this amount ONLY if you have a from offer of employment or are currently working on campus. Attach a PDF of proof of employment (copies of employment offer, emails between employers, etc.)

Proof of on-campus employment*

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(Employment offer, email from employers, etc.)

TOTAL AMOUNT AVAILABLE TO ME EVERY YEAR OF STUDY* $

The following documents are attached to prove my funding.
Please refer to the handbook for the application for a Form I-20 about acceptable documents.

My Personal Documents*

Bank/asset statement Proof of income/assets

Bank/asset statement*

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Proof of income/assets*

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Funds from Union Theological Seminary*

Award Letter Copy of Contract

Award Letter*

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Copy of Contract*

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Cash Sponsor's Documents:
All three types of evidence MUST BE ATTACHED for each sponsor providing cash support.
The Affidavit of Support and details about acceptable documents is found here. Please print the documents, fill out the document, and attach a PDF for EACH SPONSOR YOU WILL BE RECEIVING SUPPORT FROM. Retain the original physical copy for present to the consul at the visa interview as well as digital copies for your records.

Affidavit of Support from Sponsor 1*

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Proof of Income from Sponsor 1*

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Bank Statement from Sponsor 1*

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Affidavit of Support from Sponsor 2*

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Proof of Income from Sponsor 2*

No File Chosen

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Bank Statement from Sponsor 2*

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Affidavit of Support from Sponsor 3*

No File Chosen

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Proof of Income from Sponsor 3*

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Bank Statement from Sponsor 3*

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Free Room and Board Sponsor's Documents

All four types of evidence MUST BE ATTACHED for each sponsor providing cash support.
The Affidavit of Support and details about acceptable documents is found here. Please print the documents, fill out the document, and attach a PDF. Retain the original physical copy for present to the consul at the visa interview as well as digital copies for your records.

Affidavit of Support of Free Room and Board*

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Proof of Income of Sponsor of Free Room and Board*

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Bank Statement of Sponsor of Free Room and Board*

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Lease, deed, rent receipts, or utility bill as proof of residence*

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