International Supplemental Information
Special Status Student
Please write your Name in English exactly as it appears on your passport.
________________________________________________________________________________________________________
Last (Family) Name
First (Given) Name
Middle Name
Permanent Home Address
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
City
State/ Province
Country
Postal Code
Personal Information
Birthplace (City, Country)__________________________________________________________________________________
Birth Date (mm/dd/yy)_____________________________________________________________________________________
Country of Citizenship_____________________________________________________________________________________
What type of visa do you hold?
☐ F-1 Student Visa
Institution that issued the I-20 Form___________________________________________________________________
Name of the school you currently attend_______________________________________________________________
Attach a copy of the school I-20. Include SEVIS I-20 barcode number if available.
☐ J-1 Exchange Visitor’s Visa issued by ______________________________________________________________________
☐ Other Visa Type_______________________________________________________________________________________
Are you a Permanent Resident or Resident Alien of the United States? ☐Yes ☐No
If yes, please attach a copy of one of the following documents to your application:
☐ Alien Registration Card
☐ Passport page stating “Processed for I-551 Temporary Evidence of Lawful Admission for Permanent Residence”
☐ Notice of Action from BCIS for case type: I485 Notice Type: Approval Notice
Immigrant Visa Serial Number from green card_________________________________________________________________
Date Issued______________________________________________________________________________________________
✔
Are you a refugee or asylee residing in the United States? ☐Yes ☐No
If yes, please send a copy of one of the following documents with your application:
☐ I-94 admission record stamped with Refugee Status Granted
☐ I-94 admission record stamped with Asylum Status Granted
☐ Court order establishing asylum status
☐ TOPS Form 5061, Acknowledgement of Receipt of Form 589 Asylum Application
Date Issued______________________________________________________________________________________________
If you have an I-20 or DS2019 (category student) from another university, you must obtain permission from that university
before enrolling in courses at another institution. This permission should come in the form of a letter or memo included with your
special status materials. You will not be registered until this approval is received.
The University of Denver does not issue immigration documents for Special Status students.