USA Assessment for Student Study in the United States

Please complete the assessment form below and we will get back to you as soon as possible.

Gender:
Surname:
Given Names:
Address:
Telephone:
Fax:
Email Address:
Date of Birth:
Which country or countries do you hold a passport with? Please list all: name of country and passport number.
Will your spouse/dependents be travelling with you?
If yes, please list name, gender and date of birth of all dependents travelling with you:
Please describe your education history:
Please advise the preferred course type you wish to study in the USA:	1. 2. 3.
Is it your long term intention to apply for a Green Card?
Please provide details of financial support, please note that you will be expected to allocate sufficient funds for the duration of your course and you will need to be able to provide evidence of funding:
Will your parents or other family member/s be supporting you financially while you study in the USA?
If yes, please list name, relationship to you, gender and date of birth of all supporting family members:
If you are being sponsored by another person/s other than family members then please supply names and address and full details of sponsors:
Do you have a geographical preference of the area you would prefer in the USA for your further education?	1. 2. 3.
Are you an INBIB agent, if Yes please provide your Name, address and email address.

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