Personal Data

ASU ID *

Last *

First

Middle

Email Address *

Cell Number *

Nation of Birth

Nation of Citizenship

Native Language

Visa/Passport Information

Visa Type *

Visa # *

Nation Issuing

Visa Issued City

Date Visa Issued

Passport#

Nation Issuing

Passport Expiration Date

Travel/I20 Information

I94 # *

Port of Entry

I20/SEVIS ID# *

I20 Issued Date

Date You Signed I20

Local Address

Address 1- Building Name *

Address 2- Room Number *

Address 3

City

State

Zip *

Attach I20 *

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Attach I94 *

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Attach Visa *

Max file size: 10 MB

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Attach Passport *

Max file size: 10 MB

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Attach Class Schedule *

Max file size: 10 MB

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Signature and Acknowledgement

I acknowledge that by placing my initials in the text box provided the information is true and accurate. Also, I understand that changes to my local address and telephone number are permitted but must be reported.

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