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Application for Form I-20

Chase Hall • 570-408-6120 (T) • 570-408-4904 (F) • Email

Versión en español

Wilkes University
International Student Services Office

Application for Form I-20

Part 1: Personal Information

Name in Passport: Attach a copy of your passport page showing your name.

Family Name (Surname): _______________________________

First Name (Given Name): ______________________________

Foreign Address: _________________________________________________
Number and Street

City State/Province Postal Code Country

U.S. Address: ______________________________________________________
Number and Street

City State ZIP Code

Date of Birth: Month ___________ Day ___________ Year _______________

Country of Birth: ___________________________________________

Gender: Male ____________ Female ____________

Country of Citizenship: _____________________________________________

Country of Permanent Residence: _____________________________________

Marital Status: Unmarried ____________ Married ___________

If you are married, please complete the following information about your spouse and/or child (children) ONLY if they will accompany you to the United States.
Name (Family, First) Date of Birth Country of Birth Relationship to You

Name (Family, First) Date of Birth Country of Birth Relationship to You

Name (Family, First) Date of Birth Country of Birth Relationship to You

Telephone: _________________________ Fax: ______________________________

Email Address: _______________________________________________________

Have you been notified of your admission to our school? ______________________

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

Part 2: If you are in the United States NOW, complete this section. If not, go on to Part 3.

What is your Immigration Status? You can attend regardless of your Immigration Status.

______ F-1 Student. SEVIS Number: _______________________________________
Circle what your I-20 will be for:
• Transferring/Changing U.S. Schools
• Changing Educational Level/Program at Wilkes University
• Reinstatement to F-1 Status

______ Another Status. Which one? ________________________________________
Before we issue your I-20, we want to advise you. Please make an appointment to see the International Student Advisor.

Do you plan to travel outside the U.S. before school starts?
___ Yes Tell us how you would like to get your I-20 in Part 3.
___ No If you are F-1, you will receive school transfer or other instructions. If you hold another status, we
must meet with you before issuing your Form I-20.

Part 3: If you are NOT in the United States now, complete this section.

Did you recently attend school in the U.S. in F-1 Student Status?
___ No
___ Yes If yes, what was the last date of your attendance? _______________________
If you attended a U.S. school last term, and are just home on holiday between academic terms, you are considered a “School Transfer” and need to have your record transferred 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.

MAIL _____ Your Form I-20 will be sent standard airmail to the name and address you indicate in the address box. 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 isn’t possible, please contact our office. PRINT YOUR NAME AND ADDRESS IN ENGLISH, EXACTLY AS IT SHOULD APPEAR ON THE ENVELOPE.


Number and Street


BY: _________________________________________________________________________________
Name Phone Email

Part 4: Your Statement of Financial Support

Do not complete this part unless you have carefully read all instructions!

What level of education will you be pursuing? ________________________________
(Bachelor’s, Master’s, Doctorate)

What will your major be? _________________________________________________

What are you annual costs from the Workbox earlier in this packet?

Total Estimated Annual Costs ____________________________

How will you support yourself for every year of your program of study? Please check off your means of support below and indicate how much will be provided or available to you every year:

Source of my support Annual Amount

Personal Funds ____________

Funds from this school (renewable each year) ____________

Cash funds from a Sponsor (for each year) ____________

Cash funds from a second Sponsor _____________

Cash funds from a third Sponsor _____________

Free Room and Board from a local sponsor _____________

On-Campus Employment _____________
Complete this only if you have a firm offer of employment or are presently
working on campus. Attach evidence of this job.

Total amount available to me every year of study ______________
This amount must be the same or more than your minimum annual costs.

The following documents are enclosed to prove my financial responsibility:

My personal documents
____ Bank/Asset Statement
____ Proof of Income

Cash Sponsor’s documents (All three must be included)
____ Affidavit of Support
____ Proof of Income
____ Bank Statement

Funds from Wilkes University
____ Award Letter
____ Copy of Contract

Free Room and Board Sponsor’s Documents (All three must be included)
____ Affidavit of Support
____ Proof of Income
____ Proof of Residence (lease, deed, rent receipts, copy of utility bill)

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