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Registration Form

This document is a registration form for Duke Visa Services. It requests information such as name, date of birth, gender, visa type, SEVIS number, date of entry to the US, address, phone numbers, emails, and signature to register with the visa services. The form notes that it is the registrant's responsibility to notify the visa services within 10 days of any address change.

Uploaded by

Haley Hamill
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© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
40 views

Registration Form

This document is a registration form for Duke Visa Services. It requests information such as name, date of birth, gender, visa type, SEVIS number, date of entry to the US, address, phone numbers, emails, and signature to register with the visa services. The form notes that it is the registrant's responsibility to notify the visa services within 10 days of any address change.

Uploaded by

Haley Hamill
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Duke Visa Services

Registration Form
(Revised 11/12/2015. Reviewed 11/12/2015)
Please Print

Family/Last Name:
(As reflected on Passport)

Given/First Name: Middle Name:


(As reflected on Passport)

Date of Birth (mm/dd/yy): Gender: Male Female

Visa Type: F-1 J-1 H-1B TN O-1 E-3 Other

SEVIS Number: N
(Located in the upper left corner of the I-20. Located in the upper right corner of the DS-2019 (above the bar code)

Date of Entry to U.S. (mm/dd/yy):


(On I-94 Printout/Card or entry stamp from passport)

Local U.S. Address:


(Street address)

(Apt. #)

(City) (Zip Code)

**I understand it is my responsibility to notify Duke Visa Services (DVS)when I change my address within 10 days of any
move.**

Cell/Mobile Home
US Primary Phone Number
(xxx) xxx-xxxx
Required by USDHS
Permanent Overseas Phone Number: Cell/Mobile Home
(Country Code)-xxxxxxxxxx
Required by USDHS

Duke Email:
Required by USDHS

Other Email:
Required by USDHS
I verify to the best of my ability that all the information on this page is correct.

Signature Date

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