Reason for Application:

 Initial Attendance
 Transfer from Another School
THE WORLD’S COMMUNITY COLLEGE  Second Degree
 Reinstatement
Immigration Certificate of Eligibility I-20 APPLICATION  Change of Status
 Visa application

International Student Services

30-20 Thomson Avenue Room B-117 CUNY EMPL ID #:
Long Island City, New York 11101
Phone: (718) 482-5145 ________________________________
Fax: (718) 609-2021
FSInformation@lagcc.cuny.edu

Please type or print clearly in black or blue ink. Only completed applications will be processed:

STUDENT NAME: _____________________________________________________________________ Sex: Male __Female__

(As it is in passport) Family name (last name) First Middle

Current Mailing Address: ____________________________________________________________________________________

(If in the U.S., must provide street address. No post office boxes) Apt No.

___________________________________________________________________________________________________________
City State Postal Code Country

Telephone: ______________________________________ E- Mail: __________________________________________________

Area Code Number

Date of Birth: ____________________ Place of Birth: _____________________ Country of Citizenship:___________________

Month/Day/Year City and Country

Permanent Address in Home Country: _________________________________________________________________________

Street

___________________________________________________________________________________________________________
City State/Country/Zip or Postal Code Telephone (Country Code/City Code/Number)

Emergency contact name and relationship:____________________________________________ / ________________________

Emergency Email:________________________________________________ telephone #: _______________________________

Will a Spouse or Children be with you? (Please check one): Yes__ No__ If yes, list below:

_______________________________ _____________________ __________ ______________________ _______________

Name Relationship Date of Birth Country of Citizenship Country of Birth

Do you have a brother or sister studying in LaGuardia? (Please check one): Yes__ No__ If yes, list below:

_____________________________________________________________ _____________________
Name Date of Birth

F-1 VISA HOLDERS IN THE U.S FIELD OF STUDY

If you are in the U.S. as an F-1 visa student and wish to transfer to LaGuardia
Community College, please complete the following section: Please Complete the Following Section: Major code: _____ (office use)

Last school attended in U.S:_____________________________________________

Major: ____
Major: ____________________________________________________
Telephone #:___________________Last day of study: ______/________/________

F-1 Visa issue date: _____/_____/______ F-1 visa expiration date: _____/____/____ Entry year (please circle one): 2020 ____ 2021 ____

F-1 Visa number (red numbers): _________________________________________

Entry semester (please check one): Fall____ Spring ____
Passport number: ____________________________________________________

I-94 number (Check at https://i94.cbp.dhs.gov/I94/request.html)________________ Are you transferring from?

ESL program____ High school____ College____
SEVIS Identification Number: N_________________________________________

Dates of Practical Training (if any): From _____/____/_____ to _____/____/______

1. DECLARATION & CERTIFICATION OF FINANCES 3. ROOM AND BOARD AFFIDAVIT.

* When you (the student) are sponsoring yourself, you must be able to This affidavit must be accompanied with a photocopy of a lease or
provide a minimum of $34,316.00 USD / per year of study, in your own bank deed in the sponsor’s name. NOTE: Affidavit of free room and board represents
account (Please provide the most recent statement). Or if you are provided with a cash value of $16,541 USD / per year of study.
Room and Board, a minimum of $17,775 USD per year of study is required in
=
your own bank account, and section 3, 4, and 5 of this application have to be Student’s Name: _________________________________________________
completed.
Name of the student: __________________________________________________ Room and Board Sponsor’s Name: ___________________________________

Name of the Financial Institution & Location: ______________________________ Relationship of Sponsor to Student: __________________________________

___________________________________________________________________ Address of residence: Include room or apartment number offered to above

named student.
* Parent(s) or other individual sponsor(s) must be able to provide a
minimum of $34,316 USD of liquid accounts per year for your education and living ________________________________________________________________
expenses for the duration of your studies.
If the student is accompanied by an immediate family member: add an additional ________________________________________________________________
$4,212 USD for spouse and $4,212 USD for each dependent.
If student is provided with Room and Board, a minimum of $17,775 USD is ________________________________________________________________
required in sponsor’s bank account.
What will be offered to student? (Please check below)
Student’s name: __________________________________________________
ROOM: YES ___ NO ___ If yes, for 1yr__ 2 yrs __
Sponsor’s name __________________________________________________
BOARD: YES ___ NO ___ If yes, for 1yr__ 2 yrs __
Relationship to student ___________________________________________
4. AFFIRMATION OF OATH.
Address ________________________________________________________
I hereby swear to affirm upon my honor that the statements above are true and
Country _____________________ Telephone ________________________ that I will provide room and board for the student named above.

Sponsor’s Name (Print) _________________________________________

2. SPONSOR’S DECLARATION.
Sponsor’s Signature _________________________ Date ____/____/____
“I guarantee that $34,316 USD or $17,775 USD (if room and board are provided
in section 4 and 5) per year of study will be available for the above named
applicant to complete his/her field of study, and if accompanied by family, the 5. NOTARY PUBLIC:
amounts indicated in section 1 are also available for transfer and use in the United
States.” The above information was sworn and subscribed before me on

Date: _____/_____/_____
1st Sponsor’s Signature ____________________________ Date ____/____/____
Signature of Notary Public _______________________________________

Co-Sponsor’s Signature ____________________________ Date ____/____/____

SEAL
All financial documents (Bank statement and Income statement) must be dated
within the last three months. Faxed or emailed copies are acceptable (Only for
ABROAD Sponsors). Original documents have to be presented to International
Student’s Office before the classes start, and also originals have to be presented to
the US Embassy in the student’s country if applying for F-1 visa.

IF MORE THAN ONE SPON\SOR, PLEASE USE ONE PAGE PER

PERSON (Make copies of this page).

6. IMPORTANT: Your I-20 Application cannot be processed until all items in the checklist below have been received in completed form:
 Photocopy of the biographic page of your passport
 Photocopy of the biographic page of your F-1 Visa (or B1-B2, J1, etc, if you did a change of status)
 The I-94 record (Retrieve it online at https://i94.cbp.dhs.gov/I94/#/home
 Completed I-20 application form. (Be sure to complete both pages and all applicable sections of this application).
 Sponsor’s Bank Statement with the required amount. Must be dated within the last three months
 Sponsor’s Income Statement (Letter from sponsor’s employer verifying gross annual salary or Income tax returns indicating gross annual salary.)
 F-1 Transfer Students Only: Transfer form signed by DSO of the previous school. Transfer form and acceptance letter must be submitted to your
previous school in order for your record to be release to our school.
 Photocopy of all your previous I-20s

7. STUDENT DECLARATION STATEMENT – Read carefully before signing!

I fully understand that as an international student I must be enrolled for a minimum of twelve (12) equated credits per semester in my major of study and obtain at least a “c”
in every course. I will make normal and timely progress towards the completion of my major as indicated by the length of my I-20. I further understand that failure to
comply with all F-1 Visa regulations and academic requirements will place me out of status. I certify that all documents provided by me are true and correct and that the
statements in this application are correct and complete and I accept the conditions stated above.

___________________________________________________________________________________________________________________ ______/______/______
Applicant’s Signature Applicant’s Name (Print) Date

TO APPLY: Scan and email your documents at Fsinformation@lagcc.cuny.edu. Any questions please Call 718 482-5145. (Scanned documents will be temporarily
accepted for review until original are received)