Recertification From - Office of International Students and Scholars

*Student ID:

Enter you university ID

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*Name

Enter your First name last name

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Email

Enter your preferred email ID

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Phone

Enter your current phone number

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Visa Type

Select your VISA type

F-1 J-1 Other

*U.S. Address

Enter your address in US

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*Home Country Address

Enter your home country address

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Date of Birth

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City of Birth

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Country of Birth

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Country of Citizenship

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Country of Permanent Residency

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Major

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Minor(if any)

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Second Minor(if any)

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Second Major(if any)

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Education Level Seeking at USU

Have you applied for OPT/Academic training?

No Yes

Start Date(OPT)

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End Date (OPT)

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Address of employer while on OPT

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Name of OPT employer

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Contact Name

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Telephone

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I certify that the information provided in this form is true, complete and accurate. I agree to inform the Office of International Students and Scholars of any changes in these facts such as my address, education level, major, etc.

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*Verification : Please answer the question below

Name one of the three primary colors:

Office of International Students and Scholars

Office of International Students and Scholars

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