STUDENT APPLICATION FORM
Student ID :
Do you need Form I-20/student
visa (F1) ?
Part I
Family Name
US Address
City
Home Phone
Course
Date of Birth
Passport/ID Number
Part II
Type
Country of Birth
Foreign Address
Prov.&Postal Code
Fund Amount
Fund Source
Dependent(s) ? □ Yes □ No
□ Spouse
□ Children (How many ? ____)
Authorized under Federal law to enroll nonimmigrant students
□ Yes
□ No
If yes, please fill out Part I, Part II, and Part III (section A or B).
If no, please fill out Part I and Part III (section C).
First Name
State
Cell Phone
Zip Code
Email
Start Date
Gender
□ Male
Emergency Contact Person/Phone number
Inside the US :
Outside the US :
□ School Transfer
□ Initial Attendance
Country of Citizenship
□ Female
□ Change Status
City of Birth
Country
Length of Study
□ Student's Personal
Why do you want to
learn English?
□ Relative
□ Sponsor
□ Personal reason □ Academic reason
□ Professional reason □ Other (please state :________
___________)
Part III
ALL DOCUMENTS SHOULD BE IN ENGLISH
A) If you are inside the US:
 Copy of passport valid at least 6 months, visa, and Form I-94.
 Visa Waiver if applicable.
 Transfer form if applicable.
 Original bank statement (no more than 60 days old) with at least US$15,000 for one year, $10,000 for eight months,
and $5,000 for four months. (with Affidavit of Support if necessary) *For change of status students, $17000 for one year,
$12000 for 8 months, and $7000 for 4 months.
 Copy of highest diploma, certificate, transcript(s)
B) If you are outside the US:
 Copy of passport valid at least 6 months.
 Original bank statement (no more than 60 days old) with at least US$18,000 for one year, $12,000 for eight months,
and $6,000 for four months. (with Affidavit of Support if necessary)
 Copy of highest diploma, certificate, transcript(s)
C) If you are not requesting a Form I-20:
 Copy of passport or any other Gov. issued ID valid at least 6 months
 Copy of highest diploma, certificate, transcript(s)
I certify that the information supplied on this application is complete and correct to the best of my knowledge. I understand that
submitting this application does not guarantee my admission to Bluedata.
Student/Sponsor Signature _________________________________________ Date ____________________________
Director/D.S.O. Signature __________________________________________ Date ____________________________