INFORMATION SHEET

for Exchange Students applying to UIW

In most cases, the International Student Office will use the J-1 Exchange Visitor visa category for exchange
students visiting UIW, however, occasionally, we also use the F-1 Student category. Before a “Certificate of
Eligibility” (DS-2019 or I-20) to obtain a visa for visiting exchange students can be issued, the International
Student Office needs this form filled out and authorized by the school official of your own institution who
oversees the student exchange program. This Information Sheet calls for information needed for the issuance
of the “Certificate of Eligibility.” Since this form is a fillable PDF file, please enter your information, print the two
pages and get the signature of authorization. Then, fax it directly to the University of the Incarnate Word,
International Student Office, at +1-210-805-3021.

Please complete the following:

Exchange student intends to attend the University of the Incarnate Word

from ______________________________ to ____________________________________

(MM / DD / YYYY) (MM / DD / YYYY)

Biographical Information
I.

Family Name ________________________ First Name ___________________________

Male Female Date of Birth ___________ City of Birth _______________________

(MM / DD / YYYY)

Country of Birth ___________________ Country of Citizenship _______________________

Country of Permanent Residence _______________________________________________

Did this applicant ever hold a visa from the U.S. before: no yes

If so, please state visa category ____________ and dates ___________________________

Academic Information
II.

Field of studies _____________________________________________________

Level of Degree: Undergraduate

Graduate

Date of expected graduation _______________________________

(MM / DD / YYYY)
III. DOCUMENTATION OF FINANCIAL SUPPORT
Federal regulations require the university to obtain documentation to support adequate financial resources to
meet all expenses related to the exchange program. Identify below the sources of funding available for the
period of stay. Please provide evidence of support.

Amount (in U.S. dollars) Source

Item Description

Total: $0

Adequate insurance coverage is required by law. All exchange students will be required to participate in the
UIW insurance plan regardless of additional coverage by an insurance provider in your own country.

IV. Authorization

This is to certify that the above-mentioned student was selected to participate in the Student
Exchange Program with the University of the Incarnate in San Antonio, Texas, U.S.A. The
student will attend UIW for

one semester two semesters

beginning with Fall 200_ Spring 200_

Additional comments:

.......................................................................................... .......................................
(Signature of School Official) (Date)

..........................................................................................
(Name of Sister School)
For Office Use Only

DS-2019 / I-20 issued on ................................................................. By:........................................................................................

Document sent to contact person of the Sister School on ...............................................

Through UIW Admissions Office By DHL