1414 E 59th Street, Chicago, Illinois 60637
Tel. (773) 702-7752, Fax (773) 702-3058
[email protected]
http://internationalaffairs.uchicago.edu
2017-18 College SAL FRS: One Quarter
Student Information
Name as listed on passport
Surname/Family Name
Middle Name(s)
First Name/Given
Degree Program
College SAL--One Quarter
UC ID, if known
Date of Birth (mm/dd/yyyy)
Male
Female
Gender
C ountry of Birth
C ity of Birth
Country of Citizenship
Country of Legal Residence
C urrent Occupation
Please Select Occupation
Visa Category Request
Please read this information regarding the difference between an F and J visa, and indicate which of the two you prefer.
(Issuance of your visa eligibility document is dependent on your qualification for either category.)
Requested Student Status
Are you a SEVIS Transfer Student?
F-1 Student Status
J-1 Student Status
No
If you are or will be a student at another U.S. institution (including summer language programs and high schools) before attending the University of
Chicago, you should complete the Transfer-In Form and submit it to your current school.
Note: Admitted students in statuses other than F-1 or J-1 should consult with OIA regarding their eligibility to enroll in a degree program.
Dependents
Complete the information below ONLY for those dependents coming to the US and needing a visa document. If you are
bringing more than one child, please complete this form.
Spouse
Child 1
Last Name
Last Name
First Name
First Name
Middle Name(s)
Middle Name(s)
Date of Birth (mm/dd/yyyy)
Date of Birth (mm/dd/yyyy)
City of Birth
City of Birth
Country of Birth
Country of Birth
Citizenship
Citizenship
Permanent Residency
Permanent Residency
Spouse Email Address
Gender
Female
Male
Updated 5.29.12
Budget
[Required funds are estimated costs determined by program (selected above); actual costs may vary.]
Funds Required
Source of Support
See these instructions on documenting your support.
Tuition
$17,764
Student Life Fee
$511
TUITION SUBTOTAL
$18,275
Family/Friends Support
Health Insurance, Basic Plan
$1,144
University of Chicago
Books
$1,325
Student’s Government
Living Expenses (academic yr )
$5,242
Other
Personal Funds
(includes loans in your name)
(requires sponsor letter)
International Organization
Name of Organization
LIVING EXPENSES SUBTOTAL
$7,711
Please add in required amount as appropriate for dependents:
(Note: For students in 9-month MA programs, the cost per dependent is $3,000)
Accompanying Spouse ($4,000)
One Child ($4,000)
____________________________________
Other Source 1
Name of Other Source 1
__________________________________
Other Source 2
Name of Other Source 2
__________________________________
Each additional child ($4,000)
DEPENDENTS SUBTOTAL
$0
Total Funds Required
$25,986
Mailing Information
Total Support Amount
$0
[Select ONE mailing method.]
I am a student in The College. My academic unit will send the visa eligibility document to me by express mail.
Signature: I certify the information given in this form is complete and accurate.
Name (please sign)
Date
Email Address
IMPORTANT: You must print three copies of completed FRS and follow these instructions about sending your completed packet to
your academic department.