Exchange Student Check-in Form (J-1 Visa)

Exchange Student Check-in Form

If you see this don't fill out this input box.

Personal Information

myWSU ID*

SEVIS Number*(located on your DS-2019, example: N0001234567)

Last Name(s)*Family Name / Surname / Last Name(s)

First Name*First Name / Given Name(s)

Passport Expiration Date*(MM/DD/YYYY)

U.S. Telephone Number (if you have one)(if you don't have a United States phone number, please leave blank)

Address (select one)*

The Flats (2011 North Innovation Blvd)

Shocker Hall (202 N. Perimeter Rd)

The Suites (2011 North Innovation Blvd)

Other (Off-campus)

Room Number or Off-campus Address*

Building (Shocker Hall residence only)

What date did you arrive to the United States with your J-1 visa?*

Emergency Contact in the United States (can be another WSU student, friend, roommate, etc.):

Full Name*

Street Address*

Apartment Number

City*

State*

Zip Code*

Telephone*

Email Address*

Relationship*

Emergency Contact in Home Country:

Full name*

Street Address*

Address Line 2

Address Line 3*

City*

StateProvince/State

Zip Code

Country/Nation*

Telephone*(country code + city code + local number)

Email Address*

Relationship*

Certification

Do you hereby declare the Office of International Education staff to be authorized representatives eligible to view your travel history and/or most recent I-94 arrival record at www.cbp.gov as needed for immigration purposes?*

Yes

J-1 SEVIS Memorandum of Agreement

Have you read the J-1 SEVIS Memorandum of Agreement above?*

Yes

Upload Visa with arrival stamp

Upload Page 1 of DS2019