International Admissions I-20 Request Form

I-20 Request Form

Office of International Admissions
Palm Beach State Student ID
Name*

First NameMiddle NameLast NameSuffix
Email Address*
for example username@my.pbsc.edu
- Name as it appears on passport*
  
  First NameMiddle NameLast NameSuffix
- Date of Birth*
  
  MonthDayYear
- MaleFemale
- Country of Birth*
- Country of Citizenship*
- Applying for visa in home countryApplying for change of status in the USAContinued AttendanceTransferProgram ExtensionOPT/CPTDependent I-20Lost I-20ReinstatementOther
- F1F2B1/B2M1Other
- F1M1Other
- YesNo
- YesNo
- Associate of Arts (AA)Associate in Science (AS)Bachelor of Applied Science (BAS)
- Major
- School Transferring From
  Required if transferring from another educational institution in the United States
- Passport Number*
- Expiration Date of Passport*
  
  MonthDayYear
- I-94 Number
- Upload a copy of the Visa and bio pages of your passport
  
  PDF documents only
  Cancelof
- Upload copy of your I-94 (front and back)
  
  PDF documents only
  Cancelof
- Upload a copy of all previous I-20's
  
  PDF documents only
  Cancelof
- Foreign Address (Address in home country)*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Address in the U.S. (if available) / No P.O. Box
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- OPTCPTOn-CampusEconomic Hardship
- Prospective Employer Name
- Prospective Employer Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Duration of Employment
- From:
- To:
- Submit a bank letter showing a minimum balance of $24,000 USD for admissions for fall or spring terms and $28,875 USD for the summer semester
- Upload Bank Letter
  
  Cancelof
- YesNo
- SpouseChild
- Name
  
  First NameMiddle NameLast NameSuffix
- Date of Birth
  
  MonthDayYear
- FemaleMale
- Country of Birth
- Country of Citizenship
- Foreign Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Please provide proof of relationship, and copy of passport bio and visa pages for dependent.
  
  Cancelof
- YesNo
- SpouseChild
- Name
  
  First NameMiddle NameLast NameSuffix
- Date of Birth
  
  MonthDayYear
- FemaleMale
- Country of Birth
- Country of Citizenship
- Foreign Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Please provide proof of relationship, and copy of passport bio and visa pages for dependent.
  
  Cancelof
- YesNo
- SpouseChild
- Name
  
  First NameMiddle NameLast NameSuffix
- Date of Birth
  
  MonthDayYear
- FemaleMale
- Country of Birth
- Country of Citizenship
- Foreign Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Please provide proof of relationship, and copy of passport bio and visa pages for dependent.
  
  Cancelof
- YesNo
- SpouseChild
- Name
  
  First NameMiddle NameLast NameSuffix
- Date of Birth
  
  MonthDayYear
- FemaleMale
- Country of Birth
- Country of Citizenship
- Foreign Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Please provide proof of relationship, and copy of passport bio and visa pages for dependent.
  
  Cancelof
- By Typing my full name below, I declare the information above is accurate and true to the best of my knowledge. I understand that any omission or falsification may result in my rejection or dismissal from the College.*
- Date
  
  MonthDayYear
Should be Empty: