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ATTACH PHOTO HERE International Student Personal Record Form or copy of Passport Photo Please print clearly. Admission for Fall Winter Spring Academic Year - Personal Information Last/Family Name Student ID Number Female Male First Name N Date of Birth month/day/year SEVIS No* F-1 J-1 visa only Single Place of Birth City and Country Married not accompanied by spouse Single Parent complete Dependent Form Country of Citizenship Middle Name Married spouse in Riverside Local U*S* Residential Address Street Address Mobile Phone No* Apt. City Home/Campus Telephone No* State and Zip Code School Email Address Permanent Home Country Address State/Province Postal Code Country Permanent Email Address Emergency Information Who to notify in case of an illness or emergency One of your emergency contacts must be a parent guardian or spouse. If you do not have an emergency contact person in the United States please leave blank. Within the U*S* Name Relationship Home Phone No* Work Telephone No* 900 University Ave University Village Suite 204 Riverside CA 92521 2013. 06 Phone 951. 827. 4113 Fax 951. 827. 3778 Email internationalcenter ucr. edu Page 1 In Home Mobile Telephone No* Home Telephone No* Dependents If you have a spouse or children who have accompanied you please complete a Student Dependent Form* Visa Information Visa Type F-1 J-1 H-4 L-2 Other Visa Expiration Date month/day/year Other Information Have you attended U. C. Riverside before Were you attending any other university college or high school within the U*S* during the previous academic year Yes No If yes during what dates If yes which school to Name of University/College/High School In addition to this form please attach copies of the following immigration documents 1. front and back of I-94 card or I-94 print out and passport admission stamp 2. nonimmigrant visa page in your passport 3. passport face page including a copy of the renewal page if necessary 4. first and third pages of the I-20 or DS-2019 5. if you were approved for a change of status to your current status a copy of the approval notice 6. if you transferred from another school a copy of the 1st and 3rd page of your most recent I-20 from that school Page 2. Admission for Fall Winter Spring Academic Year - Personal Information Last/Family Name Student ID Number Female Male First Name N Date of Birth month/day/year SEVIS No* F-1 J-1 visa only Single Place of Birth City and Country Married not accompanied by spouse Single Parent complete Dependent Form Country of Citizenship Middle Name Married spouse in Riverside Local U*S* Residential Address Street Address Mobile Phone No* Apt. City Home/Campus Telephone No* State and Zip Code School Email Address Permanent Home Country Address State/Province Postal Code Country Permanent Email Address Emergency Information Who to notify in case of an illness or emergency One of your emergency contacts must be a parent guardian or spouse. City Home/Campus Telephone No* State and Zip Code School Email Address Permanent Home Country Address State/Province Postal Code Country Permanent Email Address Emergency Information Who to notify in case of an illness or emergency One of your emergency contacts must be a parent guardian or spouse. If you do not have an emergency contact person in the United States please leave blank. Within the U*S* Name Relationship Home Phone No* Work Telephone No* 900 University Ave University Village Suite 204 Riverside CA 92521 2013.

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Keywords relevant to Personal Record

  • I-20
  • nonimmigrant
  • 3rd
  • H-4
  • DS-2019
  • SEVIS
  • L-2
  • 1st
  • dependents
  • renewal
  • Expiration
  • citizenship
  • AVE
  • RIVERSIDE
  • APT
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