Form I-515A Notice to Student or Exchange Vistor

DEPARTMENT OF HOMELAND SECURITY

I-515A, NOTICE TO STUDENT OR EXCHANGE VISITOR

OMB No. 1653-0037
Expires 4/30/2019

To be completed at the port of entry at the time of admission:
Name
(Last Name)

(First Name)

(Middle Name)

Country of Citizenship
FINS Number

DOB
SEVIS ID Number

Admission Number
U.S. Address
(Street Number and Name)
(City)

(Apt. Number)
(State)

(Zip Code)

Telephone Number

Admission stamp with
classification and date of
authorized stay

Contact your designated school official or responsible officer immediately regarding this notice.
Your admission is limited to 30 days because you lack the required documentation.
Submit the requested documents checked.
DO NOT SEND PASSPORT.
You are an F-1/M-1 student applying for initial entry to the United States not in possession of a valid Form I-20, Certificate of Eligibility
for Nonimmigrant Student, endorsed by the school to which you are destined. Within the next 30 days, the designated official of the school
to which you are destined must complete and certify the Form I-20. Submit all of the following documents to the address listed on page 2.
1.
2.
3.

Your original Form I-20 endorsed by the designated school official;
Your original Form I-94, Arrival-Departure Record; and
This original Form I-515A.

You are an F-1/M-1 student applying for entry to the United States not in possession of evidence of the I-901 SEVIS fee payment. Within
the next 30 days, you must pay the fee via the Internet at www.FMJfee.com. Submit all of the following documents to the address listed
on page 2.
1. Your original Form I-20 endorsed by the designated school official;
2. Your original Form I-94, Arrival-Departure Record;
3. Your Form I-797 fee receipt; and
4. This original Form I-515A.
You are a returning F-1/M-1 student not in possession of an updated Form I-20 confirming that you are still enrolled in a U.S. school
certified by DHS to enroll F-1 and/or M-1 students. Within the next 30 days, the designated official of the school which you are attending
must update the Form I-20. Submit all of the following documents to the address listed on page 2.
1.
2.
3.

Your original Form I-20 endorsed by the designated school official;
Your original Form I-94, Arrival-Departure Record; and
This original Form I-515A.

You are a J-1 exchange visitor not in possession of a Department of State (DoS) Form DS-2019, Certificate of Eligibility for Exchange
Visitors, executed by the sponsor of the exchange program to which you are enrolled or registered. Within the next 30 days, the sponsor
must complete the DoS Form DS-2019. Submit all of the following documents to the address listed on page 2.
1.
2.
3.

Your original DoS Form DS-2019 endorsed in BLUE ink by the program sponsor;
Your original Form I-94, Arrival-Departure Record; and
This original Form I-515A.

You are a J-1 exchange visitor applying for entry to the United States not in possession of evidence of the I-901 SEVIS fee payment.
Within the next 30 days, you must pay the fee via the Internet at www.FMJfee.com. Submit all of the following documents to the address
listed on page 2.
1. Your original DoS Form DS-2019 endorsed in BLUE ink by the program sponsor;
2. Your original Form I-94, Arrival-Departure Record;
3. Your Form I-797 fee receipt; and
4. This original Form I-515A.
DHS Form I-515A (4/16)

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You are accompanied by your spouse and/or child(ren) at the time of entry. You should submit their original Form I-94, ArrivalDeparture Record, and their Form I-20 or DoS Form DS-2019 to the address listed below.
You are an F-2/M-2 dependent joining a spouse/parent who is a student in the United States, but are not in possession of the required
documents. Within the next 30 days, you must submit all of the documents to the address listed below.
1. A photocopy of your spouse’s/parent’s original Form I-20 endorsed by the designated school official;
2. A photocopy of your spouse’s/parent’s Form I-94, Arrival-Departure Record, verifying your spouse’s/parent’s admission into the
United States;
3. Your original Form I-94, Arrival-Departure Record;
4. Your original Form I-20; and
5. This original Form I-515A.
You are a J-2 dependent joining a spouse/parent who is an exchange visitor in the United States, but are not in possession of the
required documents. Within the next 30 days, you must submit all of the documents to the address listed below.
1. A photocopy of your spouse’s/parent’s original DoS Form DS-2019 endorsed by the program sponsor;
2. A photocopy of your spouse’s/parent’s Form I-94, Arrival-Departure Record, verifying your spouse’s/parent’s admission into the
United States;
3. Your original Form I-94, Arrival-Departure Record;
4. Your original DoS Form DS-2019; and
5. This original Form I-515A.
Other:

NOTE: DO NOT SEND PASSPORT. Failure to provide all of the original documents
requested within 30 days will result in a delay in the processing of your application and may affect
your status. All documents will be returned to the designated school official or program sponsor.
Student and Exchange Visitor Program
DHS/ICE
ATTN: SEVIS / I-515A Processing Team
500 12th Street SW STOP 5600
Washington, DC 20536-5600
Privacy Statement
Authority and Purpose: Sections 1101 and 1184 of Title 8, U.S. Code authorize DHS to collect this information. This collection of information is used to
ensure that students, exchange visitors, or dependents who are otherwise eligible to be admitted into the United States are not prevented from entering
because they do not have the proper documentation in their possession. Collection of this information provides such individuals an opportunity to provide the
necessary documentation for admission as an F, J, or M nonimmigrant.
Disclosure: Furnishing your information and providing the required documentation within the allotted time frame is mandatory. Failure to provide it may result in
denial of admission to or removal from the United States.
Routine Uses: Your information may be disclosed to the Department of State and to Designated School Officials or Responsible Officers for purposes related
to the issuance or denial of visas and for the administration of the Student and Exchange Visitor Program as well as other Federal, State, or local law
enforcement agencies for purposes related to investigations and removal proceedings for violations of immigration laws.
Burden Statement: An agency may not conduct or sponsor an information collection and a person is not required to respond to an information collection
unless it contains a currently valid Office of Management and Budget (OMB) approval number. Public reporting burden for this collection of information is
estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection
of information, including suggestions for reducing this burden, to the Department of Homeland Security, U.S.Immigration and Customs Enforcement, PRA
Officer, 801 I Street, NW STOP 5800, Washington, DC 20536-5800.

DHS Form I-515A (4/16)

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