J-1 Scholar Check in Form

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Today's Date Today's Date / MM / DD YYYY
Name Name First Last
Gender

Gender Male Female
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Email
Date of Birth Date of Birth / MM / DD YYYY
Country of Citizenship
SEVIS ID#
DS-2019 Expiration Date DS-2019 Expiration Date / MM / DD YYYY
Address in Home Country Address in Home Country
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Emergency Contact Emergency Contact First Last
Relationship:
Emergency Contact Email
Emergency Contact Phone:
Emergency Contact Address Emergency Contact Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Academic Department:
Liaison
Ext.
Maximum of 3 digits allowed. Currently Entered: 0 digits.
Taking coursework?

Taking coursework? No Yes
If yes, what course?
Marital Status

Marital Status Single Married
Upload Passport (Student)

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Upload VISA (Student)

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Upload I-94 (Student)

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Upload signed I-20 Page 1 (Student)

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Name of Dependents - Spouse Name:
Visa Status of Spouse:
Upload Passport (Spouse):

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Upload VISA (Spouse):

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Upload I-94 (Spouse):

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Name of Dependents - First Child Name:
Visa Status of First Child:
Upload Passport (1st Child):

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Upload VISA (1st Child):

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Upload I-94 (1st Child):

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Name of Dependents - Second Child Name:
Visa Status of Second Child:
Upload Passport (2nd Child):

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Upload VISA (2nd Child):

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Upload I-94 (2nd Child):

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