student record form - the ohio state university · student record form . title: microsoft word -...

OFFICE OF INTERNATIONAL AFFAIRS Student Information Last Name: ___________________________________ First Name: _______________________________ (As it appears on your Form I-20/DS-2019) SEVIS ID#: N00 ___ ___ ___ ___ ___ ___ ___ ___ Date of Birth: _______________________ (mm/dd/yyyy) (Number on top right corner of your Form I-20/DS-2019 above bar code) Local U.S. Address You MUST provide your temporary or permanent Columbus address upon arrival, as this is required for the Department of Homeland Security’s SEVIS registration. Address: ______________________________________________________ Apartment Number: ________ City: _____________________ State: ______ Zip Code: ___________ Phone: _______________________ Ohio State Email: ____________________________ Other Email: _________________________________ Emergency Contact Information and Permission In the event of an emergency during the time that I am at The Ohio State University, I give permission to representatives of the Office of International Affairs to notify the named persons of my whereabouts and/or my condition: 1. Outside of the U.S. Name of Contact: ___________________________ Relationship To You: _____________________ Address: _________________________________________________________________________ City: ________________________________________ State/Province: _______________________ Zip Code: _____________________ Country: ___________________________________________ Phone: _____________________________ Email: _______________________________________ 2. In the U.S. (if available) Name of Contact: ___________________________ Relationship To You: _____________________ Address: ___________________________________________________ Apartment Number: _____ City: _________________________________ State: __________________ Zip Code: ___________ Phone: _____________________________ Email: _______________________________________ Student’s Signature: ________________________________ Date: ____________ (mm/dd/yyyy) Office Use Only Documents Copied _______________________ Orientation Leader Data Entered _____________________ Orientation Leader File Reviewed _____________________ Immigration Coordinator Date (mm/dd/yy): __________ Comments: INTERNATIONAL STUDENTS Student Record Form

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Page 1: Student Record Form - The Ohio State University · Student Record Form . Title: Microsoft Word - Student Record Form.docx Created Date: 9/13/2016 5:32:54 PM ...File Size: 1MBPage

OFFICE OF INTERNATIONAL AFFAIRS

Student Information Last Name: ___________________________________ First Name: _______________________________ (As it appears on your Form I-20/DS-2019) SEVIS ID#: N00 ___ ___ ___ ___ ___ ___ ___ ___ Date of Birth: _______________________ (mm/dd/yyyy) (Number on top right corner of your Form I-20/DS-2019 above bar code)

Local U.S. Address You MUST provide your temporary or permanent Columbus address upon arrival, as this is required for the Department of Homeland Security’s SEVIS registration.

Address: ______________________________________________________ Apartment Number: ________

City: _____________________ State: ______ Zip Code: ___________ Phone: _______________________

Ohio State Email: ____________________________ Other Email: _________________________________

Emergency Contact Information and Permission In the event of an emergency during the time that I am at The Ohio State University, I give permission to representatives of the Office of International Affairs to notify the named persons of my whereabouts and/or my condition:

1. Outside of the U.S. Name of Contact: ___________________________ Relationship To You: _____________________ Address: _________________________________________________________________________ City: ________________________________________ State/Province: _______________________ Zip Code: _____________________ Country: ___________________________________________ Phone: _____________________________ Email: _______________________________________

2. In the U.S. (if available) Name of Contact: ___________________________ Relationship To You: _____________________ Address: ___________________________________________________ Apartment Number: _____ City: _________________________________ State: __________________ Zip Code: ___________ Phone: _____________________________ Email: _______________________________________

Student’s Signature: ________________________________ Date: ____________ (mm/dd/yyyy) Office Use Only Documents Copied _______________________ Orientation Leader

Data Entered _____________________ Orientation Leader

File Reviewed _____________________ Immigration Coordinator

Date (mm/dd/yy): __________ Comments:

INTERNATIONAL STUDENTS

Student Record Form

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