Application for Visa Document for IECP

Instructions: Please read entire form before answering questions.
This form will help us determine if you meet the financial requirements necessary for making a formal application to Penn State.

After completing this form, please send the requested documents to:

Intensive English Communication Program
The Pennsylvania State University
301 Boucke Building
University Park  PA  16802  USA

Fax: 814-863-5889
Phone: 814-865-7550

You may want to print out this page before submitting the information, so that you know what documents to send and where to send them.

If you have any questions about financial requirements or the visa application, contact the Office of International Students and Scholars (OISS) directly.

Phone: 814-865-6348
Fax: 814-865-3336
E-mail: bxn1@psu.edu
Web page: http://www.international.psu.edu

Please enter all of the requested information below.
Fields indicated in bold red are required, but all of the fields are important to the application process.

Name in full as it appears on passport:
 
Mr   Ms
Family name
First name     Middle name
Country of birth
City of birth
Country of legal residence
Country of citizenship
Most recent occupation in home country:
    (If student, state educational level)
Date of birth Day   Month   Year
Highest level of study
E-mail address
Check one category each in sections A, B, C, and D:
  1. I will come to Penn State from outside the United States  inside the United States

    (If currently a U.S. student, SEND copies of the following: your visa, I-94, and I-20 or DS-2019; plus visa and I-94 of any dependents). If you are a dependent, include copy of principal's I-20 or DS-2019 and I-94. If you arrived in the United States with any visa other than an F-1 or J-1 or J-2, attach a copy of your visa and both sides of your I-94.

  1. Document to be issued by Penn State:

    I-20 (for F-1 Student visa) My primary source of funding is personal, from own funds, family, or friend. (F-1 dependents will be issued F-2 visas.)

    DS-2019 (for J-1 Exchange Visitor/Student visa) My primary source of funding is United States or home-country government or an international organization. (J-1 dependents will be issued J-2 visas.)

    DS-2019 (for J-1 Exchange Visitor/Student visa) I am on a university-to-university exchange program.

    I do not need a Penn State document because:

    My sponsoring agency will issue it.
    I will remain on my visa
    (SEND photocopies of your visa and I-94).
    If you are now F or J, you must request a new document from Penn State.
    I am a permanent resident (SEND copy of green card).

    I have asked the IECP to postpone my admission until
    .
    (If you have already received an I-20 or a DS-2019 from Penn State, it must be returned to the University. No additional documents for a later arrival date will be issued until the original documents are returned.)
  1. Marital and Dependent Status If you do not provide financial support for dependents at time of admission, you must wait six months to apply for them to join you in the United States.

    I am not married.
    I am married but plan to come alone.
    I am married, and the following dependents will come with me:

FAMILY name GIVEN name Relationship to you Birth date
[Month Day Year]		 Birth City Country of Birth

Country of
Citizenship
M D Y
M D Y
M D Y
M D Y
M D Y
M D Y


  1. Post Program Plans:

    Undergraduate degree program in United States
    Return to home country
    Graduate degree program in United States

Proof of Finances

Current financial guarantee required is $28,510 per year for Intensive English Communication Program students. Annual expenses may be more, depending on accompanying dependents. Itemized expense estimates are listed on the Fee page under Total Annual Financial Support. Estimated cost of the mandatory medical insurance is based on the annual premium for the Penn State Insurance Plan. These figures may change as more accurate estimates become available; your I-20 or DS-2019 will show estimates at date of issue.

How long do you plan to study in the Intensive English Communication Program?

One semester
Two semesters
One year

  1. Sources of Financial Support (first year of study)

    $ Own funds: (SEND an official bank statement that includes current account balance and equivalent in U.S. dollars or current exchange rate.)
    Name of bank
    Address    
     
    $ Family or other personal support: (If guarantor is not a U.S. citizen or permanent resident, SEND notarized affidavit indicating the amount of guaranteed support and a bank statement indicating amount available to you. If guarantor is a U.S. citizen or permanent resident, an I-134 Affidavit of Support (obtainable from U.S. consulate or this office) or an equivalent form should be completed and sent to this office with current bank statement and confirmation of employment.)
    Name of sponsor
    Relationship to you
    Address  
     
    $ Government or other sponsoring agency: (The DS-2019 will be issued only for the time period specified by your sponsor. SEND a signed copy of the award letter; it must state number of years and specific amounts given each year.)
    Name of agency
    Address    
     

I certify that all information provided on this form is correct and complete. I shall notify the Intensive English Communication Program of any change in financial circumstances, or accompanying dependents, or of plans not to attend Penn State. I will return the visa document, if issued, if I postpone my admission to a later semester or do not attend Penn State. (Checking this box serves the same certification purpose as signing and dating a printed version of this application form.)
Address you would like visa document
mailed to until the date of
Month   Day   Year :		 After that date, mail document to:


Telephone number (if available)

Fax number (if available)

You may want to print out this page before submitting the information, so that you know what documents to send and where to send them.