2009 - 2010 Academic Year
ISSI 602-KN-111408 [Q] R4-W
AUTH CODE: 602-F9-4608
Page 1 of 4
Declaration anD certification of finances (Dcf)
Application for a Certificate of Eligibility (I-20 or DS-2019)
Graduate School of Engineering
360 Huntington Avenue, 130 Snell Engineering Center, Boston, MA 02115
A Certificate of Eligibility form I-20 or DS-2019 is required to apply for a student visa (F-1 or J-1) at a U.S. Embassy/Consulate. If you are currently
in the U.S. in F-1 or J-1 status, the form I-20 or DS-2019 is required to initiate a transfer-in process of your ‘Active’ SEVIS record from your current
U.S. college/school to Northeastern. If you need to apply for a change of status in order to start your program at Northeastern the form I-20 or DS-
2019 is a required document of your change of nonimmigrant status application.
Please COMPLETE THIS APPLICATION and send it along with the required supporting documents (listed in Section VIII) directly to the Graduate
School at the address above. The Graduate School will then initiate the request for your form I-20 or DS2019 by forwarding your documents to the
International Student & Scholar Institute (ISSI).
Make sure to fill out all of the applicable questions on this form.
Certify that you have at least the amount necessary to cover tuition, fees, and living expenses for the first academic year of your program plus
estimated expenses for your dependents (if any).
All required supporting documents must be in English or with an official notarized translation.
Please note the ISSI needs a minimum of two weeks to issue a university sponsored form I-20 or DS-2019.
I: PeRSONAl INFORMATION - Please Print clearly in block letters. illegible forms will not be Processed.
►Note: Your name on this application must match your full name as it appears on your passport
Always spell your name(s) consistently on all forms/applications.
□ Female □ Male
2. Marital Status: □ Single □ Married
3. Last/Family Name: