UNDERGRADUATE I-20 REQUEST

I-20 Requirements Information:

Note: This form must be completed in its entirety. I-20 Checklist

(Please check below if you do not require an I-20)
❏ I do not require an I-20 because I am a U.S. citizen or a U.S. permanent resident
(send a copy of both sides of resident alien card).
All international applicants who need an I-20 to obtain an F-1 Visa must complete
the section below:
In order to receive an I-20, you must submit the following:
1. A copy of your passport and those of your dependent(s),
if applicable
2. Completed and signed Undergraduate I-20 Request form
3. Completed and signed Financial Certificate for
Undergraduate Study
4. Bank statement or award letter dated within the last six
months.

1. Please print your name exactly the way it appears on your passport.

Last Name (Surname)__________________________________ First Name (Given)______________________________ Middle________________________________

Student ID#___________________________________________________________________________________ Gender:  ❏ Male  ❏ Female

Country of Birth_____________________________________________ Date of Birth (mo/day/year)_____________________________________________________

Country of Citizenship____________________Country of Permanent Residence____________________________ Primary Language_______________________

2. Permanent Address in Home Country:

Number and Street___________________________________________________________________________________________________________________

City ___________________________________________ Postal Code____________________________ Country________________________________________

3. Address in the United States (if known):

Number and Street___________________________________________________________________________________________________________________

City ___________________________________________ Postal Code____________________________ Country________________________________________

4. Dependents: A student who wishes to have his/her family member(s) accompany him/her must document financial support for each family member per

calendar year of study on the financial certification form provided. In addition, please provide the following information:

a. ❏ I plan to come without dependents.

b. ❏ The following dependents will accompany me (list names and relationships):

1. Name (first/middle/last)________________________________________________ Date of Birth______________ Country of Birth_______________________

Country of Citizenship_____________________________  Gender: ❏ Male  ❏ Female  Relation to you (spouse, child)__________________________

2. Name (first/middle/last)________________________________________________ Date of Birth______________ Country of Birth______________________

Country of Citizenship_____________________________  Gender: ❏ Male  ❏ Female  Relation to you (spouse, child)__________________________

Please list any additional dependents on a separate sheet of paper and attach to this form.

5. Have you been notified of your admission to Florida Tech?   ❏ Yes  ❏ No  (Please note your I-20 cannot be issued until you are accepted.)

6. If you are in the United States now, complete this section. If not continue to number 7 on back.

What is your immigration status?  ❏  F1  Another status (which one?)___________________________________

What is your SEVIS ID Number?  N_______________________________________________

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

❏  Yes (upon receipt of these forms, you will be receiving mailing instructions regarding the issuance of your I-20)

❏  No, if you are F1, you will receive school transfer or other instructions.

Florida Institute of Technology Office of Undergraduate Admission

■

150 West University Boulevard, Melbourne, FL 32901-6975 (321) 674-8030 Fax: (321) 674-8004
■ ■
SA-701-812
admission@fit.edu www.fit.edu/ugrad
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 UNDERGRADUATE I-20 REQUEST

7. If you are not in the United States now, complete this section.

Did you recently attend school in the U.S. in F1 Student status? 

❏  No

❏  Yes, what was the date of your last 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 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.

Please be sure to also complete the Financial Certificate for Undergraduate Study together with this form. Your I-20 cannot be issued without completion of
both forms.

I understand that falsification of any information on this application is grounds for immediate dismissal.

Signature of Applicant_____________________________________________________________________________Date___________________________________

Upon receipt of these completed forms, you will be receiving mailing instructions via email regarding the issuance of your I-20.

Florida Institute of Technology Office of Undergraduate Admission

■

150 West University Boulevard, Melbourne, FL 32901-6975 (321) 674-8030 Fax: (321) 674-8004
■ ■
SA-701-812
admission@fit.edu www.fit.edu/ugrad
■ Page 2 of 2