Rutgers Biomedical and Health Sciences Office of International Services
65 Bergen Street, Room GA 72, Newark, NJ 07101-1709
Phone: 973-972-6138 Fax: 973-972-8260
GENERAL REQUEST FORM
Immigration status:
F-1
Family name
First name
J-1
Street name & number
H-1
Apt. #
Permanent Resident
City
State
Rutgers ID#
Zip Code
Telephone
Other
Personal Email
Rutgers Email
I-94 Card#
I-94 card expiration date:
Beginning semester at RBHS
D/S
OR
Date
Number of credits registered for this semester
This is a request for: (Please check all that apply):
A.
I will need a new I-20/DS-2019 for:
Travel Endorsement
Dates of travel
From
to
Visa expiration date
B.
myself
my dependents
Destination (Country)
Number of entries permitted
Extension of F-1 Status
Attach department letter, proof of financial support, copies of I-20, valid passport, visa and I-94 card (front and back)
C.
F-1 Work Permission (select one)
Requested Dates:
Start Date
End Date
Curricular Practical Training
Pre-completion Optional Practical Training
Post-completion Optional Practical Training
STEM Optional Practical Training (Post Completion
Severe Economic Hardship
D.
Verification of status
E.
Other
copy of I-94 card
and/or
Approval Notice of current status
Please review web site for instructions and attach required supporting documents to request form.
http://rbhs.rutgers.edu/internationalservices/f_1/employment.shtml
Revised: 9/2014