East Central University

East Central University

I-20 DATA FORM

Note: You must complete the online application AND receive your student ID# from the International Office, before submitting this form. Do not enter a fake ID#. Forms with invalid ID#"s will not be accepted.

The following information will be listed on the Student Exchange Visitor and Information System (SEVIS) record and I-20. Unless otherwise noted to the International Office, the address listed on this form or the online admission application, may be used for delivery of the Form I-20. Applicants are required to provide true and accurate information.

APPLICANT INFORMATION

First Name:

Middle Name:

Last Name:

Date of Birth:

Gender:

Passport Expiry Date:

City of Birth:

Country of Birth:

Country of Permanent Residence:

Country of Citizenship:

Street Address:

State/Province:

City:

Zip Code:

Country:

Phone Number:

Email Address:

ECU ID#:

Did you use a recruitment agency?

Enter name of recruitment agency:

ENROLLMENT INFORMATION

Entry Term:

Entry Year:

Major of Study (ex. Computer Science):

Entry Level:

Campus:

Will you live on campus? (Note: If you are under age 21, to receive the non-resident tuition waiver you must reside on campus. Graduate students are not eligible to reside in campus housing, but will still receive the waiver.)

DEPENDENT DATA

If your marital spouse and/or dependent child(ren) will accompany you to the U.S., please provide the following information for each individual. Use the Admissions Upload portal to send a copy of their passport and/or marriage certificate/birth certificate as applicable. Additional funds must be available to support your dependents. See Estimate of Expenses sheet for dependent costs.

Marital Status:

Will family members accompany you?

If YES to previous question, then complete the following [Note: A copy of dependent's passport & proof of relationship (ex. marriage certificate, or birth certificate, in English) must be submitted]:

(1)Dependent First Name:

Middle Name:

Last Name:

Dependent Date of Birth:

Country of Birth:

Relationship to Applicant:

(2)Dependent First Name:

Middle Name:

Last Name:

Dependent Date of Birth:

Country of Birth:

Relationship to Applicant:

(3)Dependent First Name:

Middle Name:

Last Name:

Dependent Date of Birth:

Country of Birth:

Relationship to Applicant:

The above information will be listed on the Student Exchange Visitor and Information System (SEVIS) record and I-20. Applicants are required to provide true and accurate information.