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19 REQUEST 1. Family Name: (Exactly as it appears on your I-20 or DS-2019) 2. Date of Birth (mm/dd/yyyy) 3. Are you currently outside the U.S.? 4. Current Nonimmigrant Status: F-1 J-1 Note: If you hold J-1 status, do you have health and accident insurance (http://www.visaservices.duke.edu/J Health Insurance.html ) that meets the requirements of the Exchange Visitor Program? Yes 5. Given name(s): Country of Birth: Yes No No Why do you need a new I-20 or DS-2019? (check one) Travel o.

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