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Immigration and Naturalization Service Biographic Information Form

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Biographic Information
First Name:
Middle Name:
Last Name:
Gender:  Male     Female
Date of Birth:
 Month:  Day:  Year: 
Place of Birth:
 City: Country:
LSAC I.D. Number:

Address/Telephone Number
Country of Permanent Residence:
Address in Country of Permanent Residence:
Telephone Number in Country of Permanent Residence:
Mailing Address in the United States:
Telephone Number in the United States:
E-mail Address:

Citizenship and Visa Status
Country of Citizenship:
Current Visa Status:
Intended Visa Status (if different):
Purpose of Travel to the United States:

Academic Information
Degree Sought:  J.D. |   Master of Laws in US Legal Studies |   Master of Laws in Insurance
 Exchange Student |   Non-Degree Student |   Non-Student
Intended Start Date:
Intended End Date:

Financial Information (for Student Applicants)
Amount of Student's Personal Funds:
Amount of Personal Sponsor's Funds:
Amount of Funds from Other Sources:

Dependents
Please list dependents accompanying you to the United States.
Include Name, Date of Birth, Country of Birth and Relationship.

Insurance
Adequate health insurance coverage: No
Yes
Insurance Company:
Policy Number:
Group Number:
      
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