First Name: Last Name:
Middle Name: Student ID:
SEVIS ID: Class Standing:
Gender: Visa Type:
Country Of Birth: Date Of Birth:
Country Of Citizenship: Ethnicity (Optional):
Preferred Email: Howard Email:
Phone Number:
Alternate Number:
Need Social Security # ? Do you have Employment ?
Passport Number:
Passport Expiration Date:
Visa Number:
Visa Expiration Date:
I-94 Number:
I-94 Entry Date:
Port Of Entry:
Country Issuing Passport:
Program Start Date:
Program End Date:
Local Address 1:
Local Address 2:
Local City:
Local Zipcode:
Local State:
Local Phone:
Emergency Contact:
Emergency Address 1:
Emergency Address 2:
Emergency City:
Emergency Zipcode:
Emergency State:
Emergency Phone:
International Contact:
International Address 1:
International Address 2:
International City:
International Zipcode:
International State:
International Phone:
Additional Information:
Father's Full name:
Mother's Full name:
Spouse's Full name:
Guardian Full name (if under 18):
Parent/Guardian Speak English ? Religious Background (optional):

Note: You must bring copies of all your immigration documents to the ISS office to complete the registration process.

Bring copies of:

  1. i-94 document
  2. i-20 form
  3. Passport information page
  4. Visa information page