INTERNATIONAL SERVICES OFFICE UNIVERSITY OF ROCHESTER
213 Morey Hall, Box 270446, Rochester, NY 14627 Phone: (585) 275-2866 Fax: (585) 276-2943
Email: admitquestions@[Link] Web: [Link]
New Student Information Form
(Non-U.S. Citizens / Non-U.S. Permanent Residents only)
Biographical Information: Name & other information must be listed exactly as it appears in the passport.
Passport copy included Passport not available (a copy will be provided once it is issued or renewed)
Last/Surname: First/Given Name:
Middle Name: Preferred nickname:
Date of Birth (mm/dd/yy): ____/_____ /_______ Sex: Male Female Marital Status: Single Married
Country of Citizenship: Country of Permanent Residency:
City & Country of Birth: Do you have a U.S. Social Security Card? Yes No
Occupation or current academic program in home country:
Immigration Document: F-1 I-20 (recommended) J-1 DS-2019 No UR doc F & J Comparison
Select the processing options that best represent your situation. Attach any current document copies, as needed.
Initial Attendance: Entry from outside U.S. to begin a new program at University of Rochester.
Immigration Transfer of active SEVIS record: Please attach a photocopy of your current I-20 or DS-2019.
SEVIS Release Date: Current School/Sponsor:
DSO/Advisor’s Phone: DSO/Advisor’s Email:
Continue Studies at UR: Transfer back from another school (complete above) Return from absence abroad
Change of Academic Level: Between programs, do you plan to travel? Yes No To work? Yes No
Change Immigration Status to F-1 or J-1: Currently maintaining another non-immigrant status within the U.S.
Current Immigration Status: Valid until: Change By: Travel Application to USCIS
Non-UR Visa Sponsorship: IIE/Fulbright AmidEast LASPAU Other:
Home Country Permanent Residential Address: This address MUST be a physical location outside the U.S.
Street:
City: Country:
Postal Code: Phone number:
Current Email (Required):
Current or Last Known U.S. Address: Required for immigration transfer students or if residing in the U.S. currently.
Street:
City: State: Zip: Phone:
Emergency Contact: English language speaker requested.
Name: Relationship to you:
Phone number: Email:
New Student [Link]; January 2017
Proof of Financial Support: Not Applicable: All expenses will be covered by University of Rochester.
Sources of Support: Documentation must be in English or with translation. Funds do not have to be in U.S. dollars.
Personal Funds: $ Home Institution Funding: $
Family (Attach copy of support letter): $ Anticipated UR Funding: $
Home Government: $ Other: $
Dependent Spouse/Child: Yes No Use the Dependent Information Form to list details for any dependent
requiring F-2 or J-2 visa sponsorship & attach a copy of their passport ID page. Show additional $7000/person above.
Consent for ISO to access the Form I-94 Record: I authorize the University of Rochester’s International Services
Office to access the electronic I-94 arrival and departure record for myself and any dependents.
Student Signature: Date:
Submit completed form and supporting documents to UR admitting department!
UNIVERSITY USE ONLY Student’s UR ID#:
English Proficiency Evaluation: English prep/study at UR: Required Recommended Optional
Standardized English test: TOEFL IELTS PTE Other:
Student’s Score = Target/Minimum Score = Required Recommended
Interview: Date: Name: Proficient English: Yes No
Other Standardized Test or Evaluation (Please explain):
Assessment Waived: Native speaker Previous degree ESL study Other:
Academic Program: Level of Study at UR:
UR Division: Bachelor
Masters
Major/Program:
Doctorate
Start Date: / / Completion Date: / / Certificate
Visiting Student
Annual Expenses: Financial Support:
Template Name: Total Annual UR Support: $
Total: $ Scholarship:
Contact ISO for Expense Template details. Assistantship:
Fellowship:
Other UR Support: ________________
Dependent Expenses: $ Total Non-UR Support: $
Total Expenses: $ =< Total Support: $
Not Applicable: Financial information is NOT required for Non-UR Visa Sponsorship students.
Department Certification: This student has met all requirements for admission to the program of study identified
above and has shown sufficient evidence of financial responsibility for the intended study.
Completed By (Signature): Phone:
(Printed name): Date:
