Please complete the form below for items 1-14 and provide the appropriate documentation for items 15-17.

1)   Student name (as it appears in passport)

2)   Foreign address

3)   Local address, if applicable

4)   Date of Birth*

5)   Country of Birth*

6)   Country of Citizenship*

7)   Program Enrolled In

8)   Degree Sought

9)   Beginning date of studies

10)    Ending date of studies

11)    Level of English proficiency

12)    Estimate of student’s average costs for 9 or 12 month academic term, i.e., tuition and fees, living expenses, etc.

13)    Financial support, i.e., evidence of student’s personal funds, funds from EVMS, funds from other sources, on-campus employment, etc.

14)    If student has dependents I will also need this information on each dependent, including their full name and relationship to student

15)    Copy of passport title page

16)    If currently in US, a copy of visa page in passport

17)    Copy of both sides of I-94 form (if currently in US)