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SEVIS Supplement Form

The Student and Exchange Visitor Information System (SEVIS) is an internet-based system that provides the United States government, educational institutions and exchange programs an automated means to exchange timely information about foreign students, exchange visitors and their dependents. All colleges and universities must comply with SEVIS regulations. The information you provide below will assist Columbia College staff in issuing the I-20 Certificate of Eligibility.

Note: Items marked with an * are required.

Personal Information
Applicant's Name*

Last

First

Middle

Permanent Foreign Address:
Street
City* State/Province
Country* Postal Code

Mailing Address

Mailing address will be used for shipping of the I-20 Certificate of Eligibility.

Street*
City*
State / Province
Country*
Postal Code
Email:*
Date of Birth:

Day/Month/Year*

Gender:* Male   Female
Country of Citizenship:* Country of Birth:*
Dependent Information
Name

( Last, First, Middle)

Date of Birth:

Day/Month/Year

Gender: Male   Female
City of Birth: Country of Birth:
Country of Citizenship: Visa Type:
Relationship to Applicant:

**You must provide dependent information for EACH dependent family member travelling with you to the United States. Please attach additional pages if necessary.

Attachments

Allowed file types are .doc, .docx, .pdf, .rtf, and .txt

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*