Application for Visa Document
Semester for Which You Have Applied: _________________
Instructions: How to Complete the Application for Visa Document and Financial Certification
This form will help us determine whether you meet the financial requirements necessary for being issued a Certificate of Eligibility
for Student Visa (I-20 or DS-2019). All international students must show evidence of their finances before we can issue a visa
document. The law requires us to be assured that you will have enough money to meet educational and living expenses for each year
that you plan to study in the United States.
Name in Full as it appears in passport:
City of Birth:
Date of Birth (mo/day/year):
Gender: male female Have you attended Penn State before: yes no
Most recent occupation in home country (if student, state educational level):
Are you now in the United States on an F-1 or J-1 student visa?
or have you been in the U.S. on a student visa and you will have
been outside the U.S. for 5 months or less when the Penn State
or are you planning on entering the U.S. on a student visa for
another school to attend a language program or engage in
other short term study prior to coming to Penn State?
Which school in the US?
Please send copies of the following documents:
your current visa
all I-20s and/or DS-2019s
your current I-94
I-94s and visas of all dependents
If you answered “yes” to any of the above, you will receive a “Request
for Release of SEVIS Data” after you have accepted your offer of
admission. You would present that request to the school you listed
above to ask them to release your data in SEVIS (the international
student tracking database).
Marital and Dependent Status: If your dependents (spous