I-20 Request Form

Please submit by:

• May 31st for fall entrants
• September 30th for spring entrants

All New International Students:
Please either mail, fax, or send a scanned version (as email attachment) of the ID page from your passport to our office.  We need to receive it by either May 31st (fall entrants) or September 30th (spring entrants)!

International Students Currently in the United States:
Please mail our office photocopies of the documents listed below so that we receive them by either May 31st (fall entrants) or September 30th (spring entrants):

• ID page from your passport
• Visa stamp in passport
• Both sides of your I-94 form
• Both sides of your I-20 form (for F-1 students) or DS-2019 form (for J-1 students)

Mail to:
McCulloch Center for Global Initiatives
Porter Hall, Mount Holyoke College
50 College Street, South Hadley, MA 01075 USA

Fax: 001-413-538-3385

* Required fields

1. Your First Name: *
   
   
   
2. Your Last Name: *
   
   
   
3. Your MHC Email:*
   Note: If you don't yet have your MHC email,
   type your last name and then@mtholyoke.edu
   
   
   
4. Country of Citizenship: *
   
   
   
5. Country of Residence
   (the country in which you/your parents permanently reside and pay taxes, if applicable):
   
   
   
6. Date of Birth: (date: mm/dd/yyyy) *
   
   
   
7. Country of Birth: *
   
   
   
8. City of Birth: *
   
   
   
9. Current Address: *
   
   
   
10. Current Telephone: *
    
    
    
11. Current Fax:
    
    
    
12. Current Email: *
    
    
    
13. Current address valid until: (date: mm/dd/yyyy) *
    
    
    
14. Permanent Address: *
    
    
    
15. Permanent Telephone: *
    
    
    
16. Permanent Fax:
    
    
    
17. Permanent Email: *
    
    
    
    PASSPORT INFORMATION:
    
    
18. Issued by (country): *
    
    
    
19. Expiration Date: *
    
    
    
    IF YOU CURRENTLY LIVE IN THE US:
    
    
20. What is your SEVIS ID number:
    
    
    
21. Current visa status (from I-94):
    
    
    If you are or have been attending high school or college in the US, you must ask your current or most recent adviser to complete the SEVIS Transfer Release Form for Students Currently in the US.
    
    
    
    
22. Do you plan to travel outside of the US prior to your arrival at Mount Holyoke?
    Yes No
    
23. If yes, please indicate the approximate dates you plan to travel:
    
    
24. Will you be traveling to your home country during this time?
    Yes No
    
    

    IF YOU CURRENTLY LIVE OUTSIDE OF THE US:
    

    
    
25. Have you entered or studied in the US
    
1. as an F-1 student Yes No
2. as a J-1 Exchange-Visitor Yes No
3. in any other visa statusYes No
   
   
26. If you clicked "yes" on any part of question 25, please list all the dates for each visa status and where you lived or studied:
    
    
27. Approximate date of your planned departure to travel to the US:
    (date: mm/dd/yyyy)