International Student

Student Information Form

* Denotes A Required Field

Personal Information

First Name:*

Middle Name:

Last Name:*

G Number:*

Date Of Birth:*
Month: Day: Year:

Gender:*

Place of Birth

City of Birth: *

Country of Birth: *

Local Allendale / Grand Rapids Area Address

Address: *

Address 2:

City: *

Postal Code: *

Home Phone: *

Cell Phone: *

Email Address: *

Your Country

Home Address: *

Home Address 2:

City: *

State / Province: *

Country: *

Postal Code: *

Emergency Contact Information for Family Member

First Name:*

Last Name:*

Relation:*

Language Spoken:*

Phone Number:*

Cell Phone Number:

Email:*

Address: *

Address 2:

City: *

State / Province: *

Country: *

Postal Code: *

Educational Information

Date beginning at GVSU:*
Month: Day: Year:

Expected Graduation Date:*
Month: Day: Year:

Major:*

Degree: *

Home Institution:

Transfer Student (from a school in the US): *

Immigration Information

Date of Entry into U.S.:*
Month: Day: Year:

Port of Entry:*

Passport Nationality:*

Passport Number:*

Expiration Date of Passport:*
Month: Day: Year:

Type of Visa:*

Statement of Release

I hereby release GVSU to take whatever medical or other action as may be deemed necessary (in an emergency situation only) if "Emergency Contact" person named above cannot be contacted.

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