Name*

First Last

Student ID Number*

If you don't know your student ID number, please contact

Date of Birth*

This term I am:*

Next term I plan to:*

Home Address*

Current Address*

Email*

Current Phone*

Cell Phone*

Home Phone*

Major*

Expected Graduation Date*

If in Education, what is your expected date of student teaching?

Are you also a US Citizen, US Permanent Resident, or do you hold a TN visa?*

Are you Native American?*

How many credit hours will you enroll for THIS semester?*

Generally, 1 class = 3 credit hours

Is this student teaching?*

How many credit hours will you enroll for NEXT semester?*

Generally, 1 class = 3 credit hours

Is this student teaching?*

SEVIS ID number*

I-94 Admission Number*

Found on the white card stapled to I-20 or passport

Passport Number*

Passport Issuing Country*

Passport Expiration Date*

Visa Number (not required for Canadian students)

Visa Expiration Date

Please check your I-20's program completion date. If your I-20 shows a program completion date before your actual graduation date please see us to request an extension to your program completion date. Also, you must be enrolled for at least 12 credit hours each semester, so please see us if you will need to study part-time