Student Visa Document Request - UCI International Center

UCI International CenterStudent Visa Document (I-20 or DS-2019) Request FormSECTION ONE: PERSONAL INFORMATIONTODAY’S DATE [MM/DD/YYYY]: UCI STUDENT ID #:LAST NAME:DATE OF BIRTH [MM/DD/YYYY]:TELEPHONE:LOCAL ADDRESSSTREET ADDRESS:FIRST NAME:SEVIS NUMBER: NEMAIL:HOME COUNTRY ADDRESSSTREET ADDRESS:CITY: CITY: PROVINCE:STATE: ZIP CODE: COUNTRY: POSTAL CODE:SECTION TWO: REASON FOR REQUEST ACADEMIC MAJOR/MINOR CHANGE OR A DDITION• COPY OF I-94 DOCUMENT CHANGE OF DEGREE LEVEL• CHANGE OF DEGREE LEVEL FORM (GRADUATE DIVISION)• ACADEMIC STATUS VERIFICATION FORM (ON IC WEBSITE)• FINANCIAL DOCUMENTS (SEE SECTION FOUR)• COPY OF I-94 DOCUMENT RETURNING STUDENT(RE-ADMIT OR RETURNING AFTER LEAVE OF ABSENCE)• FINANCIAL DOCUMENTS (SEE SECTION FOUR)• PASSPORT BIOGRAPHICAL INFORMATION PAGE• ACADEMIC STATUS VERIFICATION FORM (ON IC WEBSITE) FINANCIAL INFORMATION CHANGE• FINANCIAL DOCUMENTS (SEE SECTION FOUR)• COPY OF I-94 DOCUMENT REINSTATEMENT TO F-1 OR J-1 STATUSAPPOINTMENT WITH INTERNATIONAL STUDENT ADVISOR IS REQUIREDPRIOR TO REQUESTING A VISA DOCUMENT PROGRAM EXTENSION or SHORTEN• FINANCIAL DOCUMENTS – for extension only (SEE SECTIONFOUR)• ACADEMIC STATUS VERIFICATION FORM (ON IC WEBSITE)• COPY OF I-94 DOCUMENT CHANGE OF STATUS• PLEASE COMPLETE SECTION THREE OF THIS FORM• FINANCIAL DOCUMENTS (SEE SECTION FOUR)• ACADEMIC STATUS VERIFICATION FORM (ON IC WEBSITE)• IF YOU HAVE DEPENDENTS, COMPLETE DEPENDENT REQUESTFORM (ON IC WEBSITE)• PASSPORT BIOGRAPHICAL INFORMATION PAGE REPLACEMENT OF I-20 OR DS-2019(LOST, STOLEN, DAMAGED, OPT ETC.)• SPECIFY REASON: _____________________________• COPY OF I-94 DOCUMENT• CHANGE EMPLOYERS NAME CHANGE• PASSPORT BIOGRAPHICAL INFORMATION PAGE• COPY OF I-94 DOCUMENT TRAVEL(TRAVEL SIGNATURE SPACE FULL ON VISA DOCUMENT)• TRAVEL FORM (ON IC WEBSITE)• COPY OF I-94 DOCUMENT[IF APPLICABLE] SECTION THREE: CHANGE OF STATUS INFORMATIONWHY ARE YOU REQUESTING A CHANGE OF STATUS TO F/J1? PLEASE EXPLAIN.WHAT IS YOUR CURRENT VISA? __________________HOW WILL YOU APPLY FOR YOUR NEW VISA STATUS TO F-1 OR J-1 STUDENT STATUS? [MARK ONLY ONE] INSIDE THE U.S. BY FILING A CHANGE OF STATUS APPLICATION WITH THE U.S. CITIZENSHIP AND IMMIGRATION SERVICE (USCIS) APPLYING FOR AN F-1 OR J-1 STUDENT VISA IN YOUR HOME COUNTRY• For more information, review the CHANGE OF STATUS to F-1/J-1 Information Sheet on the IC website.UCI International Center • Irvine, CA 92697-5255 • P: 949.824.7249 • F: 949.824.3090 • internationalcenter@uci.edu • www.ic.uci.eduIC Office Use Only: Date Received: __________ Advisor’s Initials: ___________ Ready for Pick-Up On: _________________ | Revised On 02.25.2014[1]

UCI International CenterStudent Visa Document (I-20 or DS-2019) Request FormSECTION FOUR: FUNDING INFORMATION FOR 2014-2015LEVEL OF STUDY: EAP UNDERGRAD GRADUATE MBA LAW MPH MPP ADV. TOCANDIDACYPERDEPENDENTTUITION/FEES: WAIVED $37,386 $30,657 $47,091 $53,804 $33,414 $33,753 $15,555 $4,000LIVING EXPENSES:ACADEMIC YEAR (9 MONTHS) REQUIRES $17,000 ($5,666 PER QUARTER)TOTAL: $17,000 $54,386 $47,657 $64,091 $70,804 $50,414 $50,753 $32,555 $4,000SOURCE OF FUNDING [IF APPLICABLE] SELF/PERSONAL FUNDS• ATTACH BANK STATEMENT/LETTER [MUST BE IN ENGLISH AND U.S. DOLLARS] $: ______________________ FAMILY/PRIVATE FUNDS• ATTACH BANK STATEMENT/LETTER [MUST BE IN ENGLISH AND U.S. DOLLARS]• SIGN AFFIDAVIT OF FINANCIAL SUPPORT BELOW [IF SPONSOR IS OUTSIDE OF THE U.S.,OR PROVIDE A LETTER OF SUPPORT FROM SPONSOR]AFFIDAVIT OF FINANCIAL SUPPORTI have read the information about the amount needed for tuition/fees and living expensesrequired for the period of my study at UCI. I certify that funds in the amount stated on this formare available and I accept responsibility for these expenses. I have provided a current bankstatement that verifies that funds are available.SIGNATURE OF SPONSOR: _______________________________________________________NAME OF SPONSOR:____________________________________________________________RELATIONSHIP TO STUDENT: _____________________________________________________ UNIVERSITY OF CALIFORNIA, IRVINE• NAME OF DEPARTARTMENT PROVIDING FUNDS: ______________________________• SCHOOL OF: ____________________________________________________________• DEPARTMENT CONTACT NAME & TITLE: _____________________________________$: ______________________I certify that funds are available for the student to cover tuition/fees and/or living expenses inthe amount stated.DEPARTMENT SIGNATURE: ______________________________________________________TELEPHONE NUMBER: __________________________________________________________$: ______________________ AGENCY, GOVERNMENT AGENCY, HOME UNIVERSITY• ATTACH AWARD/FUNDING LETTER• NAME OF AGENCY: _____________________________________________________ $: ______________________IMPORTANT REMINDERS• STUDENT MUST BE ENROLLED FULL-TIME EACH QUARTER (12 UNITS) UNLESS AUTHORIZED BY THE INTERNATIONAL CENTER• IF YOU ARE CURRENTLY ON FILING FEE, OR AUTHORIZED FOR REDUCED COURSE LOAD (PART-TIME) BECAUSE YOU ARE IN YOUR LASTQUARTER, YOU ARE NOT ELIGIBLE FOR AN EXTENSION OF YOUR I-20/DS-2019. PLEASE CONTACT THE IC FOR AN APPT. WITH A STUDENTADVISOR.• IF YOU ARE EMPLOYED AT UCI YOU ARE REQUIRED TO PROVIDE A PHOTOCOPY OF YOUR NEW I-20 TO THE HIRING DEPARTMENT FORUPDATE OF EMPLOYMENT RECORDS.I CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE. I AM AWARE THAT I MUST PROVIDE DOCUMENTATION TO SUPPORT THE I-20/DS-2019 REQUEST.STUDENT SIGNATURE: _________________________________________________DATE: _______________________________UCI International Center • Irvine, CA 92697-5255 • P: 949.824.7249 • F: 949.824.3090 • internationalcenter@uci.edu • www.ic.uci.eduIC Office Use Only: Date Received: __________ Advisor’s Initials: ___________ Ready for Pick-Up On: _________________ | Revised On 02.25.2014[2]