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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. Your application for admission to Columbia College cannot be processed until this completed and signed SEVIS supplemental form is received.

Note: Items marked with an * are required.

Personal Information
Last First Middle
Applicant's Name:*
Permanent Address:*
Date of Birth:
Gender:* Male   Female
City of Birth:* Country of Birth:*
Native Language:* Primary Language:*
Secondary Languages
Number of years of instruction in English language:*
Do you intend to enroll in English as a Second or Other Language (ESOL) course?* Yes   No
TOEFL Examination Date: TOEFL Score:
Are you currently attending another
college or university in the United States?*
Yes   No
Name of College or University:
Location of College or University (City & State):
Port of entry into the United States:
Date of entry into the United States:
Dependent Information
Name (Surname, First, Middle):
Date of Birth:
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. Please attach additional pages if necessary.


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

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