Application for Full-Time International Students (I-20 Form)
 
Name: _______________________________________________________________________________________________
family name given name
 
Date of birth: __________ Country of birth: ___________________ Country of Citizenship: ______________________
 

month/day/year          
Gender (please check one): Male Female
 
Phone: __________________________________________ Email: ________________________________________________
 
Home Address in Native Country: _____________________________________________________________________________
 
____________________________________________________________________________________________________
 
Local US Address: _______________________________________________________________________________________
        street   city/state postal code  
____________________________________________________________________________________________________
 
Signature: ___________________________________________________ Date of application: ___________________
   

        month/day/year  
Admission Request (please check one): Fall Spring Summer I Summer II
 
I-20 Request (for F-1 Student Visa)
 
I am applying as a: (please check one)
1. New Student for the English Language Institute (only for ELI) - Applying from overseas .
2. New Student for both the English Language Institute and for Queens College admissions* - Applying from overseas.
*Provide a personal statement or letter of intent. Include your intended major area of study and goals.
3. Transfer Student - Transferring from another school to the English Language Institute of Queens College.
4. New Student - Requesting a change of status.
 
Receiving your I-20 (please check one): Will pick up Mail overseas Mail Locally
 
Type of Financial Support Information (please check one box):
 
1. Student's own original official bank statement on letterhead in English and in US dollars.*
2. Sponsor form overseas affidavit of support. 2. Original bank statement on letterhead in English and in US dollars.*
3. US sponsor's affidavit of support. 2. Original bank statement on letterhead in English. 3. Proof of income.
*An official document of monthly account activity, including account number, balance, deposit & withdrawls.
 
Enclose Payment: Application fee of $80. Check or money order made out to "Queens College." No cash please.
 
Submit all of the following:
 
1. This completed application . 2. An $80 check or money order. 3. A copy of your passport. 4. Your financial support information.*
5. If you are under 18 years old, a copy of your high school diploma or university records.
* You can use either the ELI affidavit of support OR form I-134.
 
English Language Institute Visa Office at Queens College
Kiely Hall Room 111 , 65-30 Kissena Boulevard , Flushing, New York, 11367-1597 USA
TEL: 718-997-5718 FAX: 718-997-5723 EMAIL: inga.mezale@qc.cuny.edu