Mercer County Community College
Office of International Students
Application for Form I-20
Print this form, then mail the signed, completed form to:

Coordinator of International Students
Mercer County Community College
PO Box B
Trenton, NJ 08690

Last (Family) 
Name		 First (Given) 
Name
Country of Birth Date of Birth 
(Month/day/year)
Country of Citizenship  
Address in Home Country 

 
Are you currently in the United States?      Yes         No 

Answer these questions only if you are currently in the United States.
Circle your current immigration status: F-1   B-1  B-2  J-1  J-2 
Other _______ (Please fill in the other status.)
What is your Form I-94 (Arrival/Departure Record) Admission Number (11 digits)? What is the date of your last entry into the United States?
What is the expiration date of your I-94?  
____  I have attached photocopies of my identification and expiration date pages of my passport, the visa stamp and both sides of my I-94.
For the following questions, circle either Yes or No.
Are you planning to leave the U.S. before beginning your studies at Mercer? Yes      No
Do you intend to keep your current immigration status? Yes      No
Has your immigration status been changed since your entry into the U.S.? Yes      No

Please answer all of these questions.

Are you married?        Yes  No
If your spouse and/or children are coming with you, please complete the following:
Name of Each Person Coming with You Relatioship 
(wife,husband, 
son, daughter)		 Date of Birth 
(month/day/year)		 Country of 
Citizenship
1      
2      
3      
4      
5      
6      
Are you a transfer student from another U.S. institution?    Yes  No
Did you attend the school that issued your last I-20?        Yes  No
Is English your native language?         Yes    No 
If no, what is your native language?
Please indicate how you will show evidence of your English language proficiency: 
___  TOEFL     Test Date ____________    Test Site _______________ 
___  Intensive English as a Second Language (ESL) program at an accredited U.S. institution.  Send an official transcript or certificate of completion. 
___ 3 credits of a college-level English composition course (with a grade of C or higher).  Send an official transcript from a U.S. college.
Student's 
Signature		 Date