Cleveland State University

Center for International Services and Programs

Request For F1/J1 Dependent's I-20

Student Information
Date
Student ID
Last Name
First Name
Study Level
Department
Student Type
 Initial Student    Continuing Student
DEPENDENT'S INFORMATION
Please list names, birth dates, places and nationality of all dependents as it appears on their passport
For F1 dependents please fill place of birth and for J1 dependents please fill city and country of birth

Last Name
Middle Name
First Name
Gender
 Male    Female
Date of Birth (mm / dd / yy)
Place of Birth
For F1 dependents
City of Birth
For J1 dependents
Country of Birth
For J1 dependents
Citizenship
Relationship to Student
DEPENDENT'S INFORMATION
Last Name
Middle Name
First Name
Gender
 Male    Female
Date of Birth (mm / dd / yy)
Place of Birth
For F1 dependents
City of Birth
For J1 dependents
Country of Birth
For J1 dependents
Citizenship
Relationship to Student
DEPENDENT'S INFORMATION
Last Name
Middle Name
First Name
Gender
 Male    Female
Date of Birth (mm / dd / yy)
Place of Birth
For F1 dependents
City of Birth
For J1 dependents
Country of Birth
For J1 dependents
Citizenship
Relationship to Student

Please note that you have to provide additional financial information for your dependents:
                       Spouse  $ 3500     Child $ 2000       2nd Child $ 1500
Please select appropriate statements:
How to obtain your I-20?
If you choose mail I-20, What is your address?

    
engaged learning
Mailing address
Cleveland State University
Center for International
Services and Programs
2121 Euclid avenue
Cleveland, OH 44115-2214
Campus Location
Main Classroom, Room MC106
1899 East 22nd Street
Phone: 216.687.3910
study@csuohio.edu


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