Student Check in Form1
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International Student Check-In Form Date: / / Please complete the following: Full Name:___________________________ _ ________________________________ _____ G Number:G00____________ I am a: □ New student □ Returning student Expected Graduation Date: ___________________ ___ I20/DS2019 End Date: ___________________ ___ Academic Level and Visa Type: □ Undergraduate F-1 □ Graduate F-1 □ Undergraduate J-1 (exchange) □ Graduate J-1 (exchange) □ Other___________________ How many hours are you enrolled this semester:________ Did you travel home this break? Yes □ or No □ If yes, please print out your new I-94 at the link below . Keep one copy and provide ISS with one copy. Current Address:_________________________________________________ ____ Apt/Room #__________________ City:____________ _____ __ State:_____________ Zip Code:____________ Did you received a new passport or Visa: Yes □ or No □ If yes, please bring your passport or visa to ISS to make a copy. Email Address:________________________________@missouriwestern. edu Cell Phone: (____) _______________ Emergency Contact Information: Contact Do you have MWSU insurance through
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Transcript of Student Check in Form1
International Student Check-In FormDate: / /
Please complete the following:
Full Name:____________________________
_____________________________________
G Number:G00____________
I am a:
□ New student□ Returning student
Expected Graduation Date:
______________________
I20/DS2019 End Date:
______________________
Academic Level and Visa Type:
□ Undergraduate F-1□ Graduate F-1□ Undergraduate J-1 (exchange) □ Graduate J-1 (exchange) □ Other___________________
How many hours are youenrolled this semester:________
Did you travel home this break?
Yes □ or No □
If yes, please print out your new I-94 at the link below. Keep one copy and provide
ISS with one copy.
Current Address:_____________________________________________________
Apt/Room #__________________ City:____________ _____ __
State:_____________ Zip Code:____________
Did you received a new passport or Visa:
Yes □ or No □
If yes, please bring your passport or visa to ISS to
make a copy.
Email Address:[email protected] Phone:
(____) _______________
Emergency Contact Information:
Contact name:________________________________________Relationship:_____________________
Street number and name:_______________________________________________________________
City:____________ State:__________ Zip Code:_____ Phone#(____)__________
Do you have MWSU insurance through
Lewermark?Yes □ or No □
If no, provide insurance card copy
If so do you plan to spend next summer in the U.S.?
Yes □ or No □http://cbp.gov/xp/cgov/travel_visa/i-94_instructions/I understand that I must report any changes in biographical information (address, etc.) within 10 days of the change to International Student Services.
STUDENT’S SIGNATURE: _____________________________________________DATE__________________________
This form must be turned in to International Student Services, Blum 210. You must meet with someone from the ISS office when you turn in the form. You may NOT email or fax this document.
