SEVIS REGISTRATION
Please complete this form and answer all fields ONLY after you have arrived in the United States. If you have questions or require additional assistance, please contact us. PLEASE NOTE: All fields with a "*" must be filled out!
PERSONAL INFORMATION
Name (as it appears on DS2019)
*
First Name
Last Name
DS2019 Number
*
Date of Birth (mm/dd/yyyy)
*
US Arrival Date (mm/dd/yyyy)
*
/
Month
/
Day
Year
Date Picker Icon
Country of Origin
*
E-mail
*
U.S. Mobile/cell phone number
*
-
Area Code
Phone Number
EMPLOYER INFORMATION
EMPLOYER NAME
*
Employer Address
*
Employer City, State, ZIP
*
Employer Phone
*
-
Area Code
Phone Number
Employer Email (or Personal Email)
HOUSING INFORMATION
Housing Facility Name (i.e., Hancock Apts, Private House, Motel/Inn)
*
Housing Address (i.e., 12 Maple Street)
*
Apartment or Room Number (Enter "none" if no number)
*
Housing City, State, ZIP
*
Housing Phone (or Personal Phone)
-
Area Code
Phone Number
Housing Email (or Personal Email)
Enter the message as it's shown
*
Submit Form
Should be Empty: