Dependents Form - Request for visa document for accompanying dependents

COMPLETE THIS FORM ONLY IF FAMILY MEMBERS (WIFE, HUSBAND, OR CHILDREN UNDER AGE 21) WILL BE ACCOMPANYING YOU TO THE UNITED STATES OR IF YOUR FAMILY MEMBER(S) REQUIRE(S) AN I-20 OR DS-2019 TO APPLY TO CHANGE VISA STATUS TO F-2 OR J-2.   Unless they have U.S. citizenship, all family members must carry their own I-20  or DS-2019 Forms and apply for F-2 or J-2 visas.  Provide the following information for each dependent.  Use an additional sheet of paper if needed.  Proof of additional funds is required in the amount of $6,000/year for a spouse and $4,000/year for each child for F-2 dependents, and $600/month for a spouse and $350/month for each child for J-2 dependents.  Information provided must match passports.

Visitors on J-2 visas are required to have health insurance coverage and visitors on F-2 visas are strongly encouraged to have health insurance. You will find details on the health insurance requirement on the Health Insurance and Immunizations web page. Dependents do not need to arrive and depart at the same time as the primary F-1 or J-1 visa holder. They may enter later and leave earlier than the primary. However, proof of funding for dependents must include the entire stay of the primary. 

An e-mail address for each dependent is required by the U.S. Department of State. If a dependent does not have an e-mail address, you may substitute your own e-mail address.

You will not be able to save this form and continue later.  Please be prepared to upload passports for each dependent that will be accompanying you while you study at Cal Poly.

Student or Scholar Information
Enter your name as it appears on your passport
Upload additional documented proof of funds if needed.
Files must be less than 2 MB.
Allowed file types: gif jpg png pdf doc docx zip.
If you have not already provided proof of financial support for your dependents when you applied for your visa document from Cal Poly, please provide that here.
Files must be less than 2 MB.
Allowed file types: gif jpg png pdf doc docx zip.
Information about Spouse
Enter information about spouse as it appears on the passport.
Files must be less than 2 MB.
Allowed file types: gif jpg png pdf doc docx.
If bringing spouse, please provide marriage certficate.
Files must be less than 3 MB.
Allowed file types: gif jpg jpeg png pdf.
Information about Child
Enter information about child as it appears on the passport.
Files must be less than 2 MB.
Allowed file types: gif jpg png pdf doc docx.
If your child does not have an e-mail address please provide your own e-mail.
Information about Additional Child
Enter information about child as it appears on the passport.
Files must be less than 2 MB.
Allowed file types: gif jpg png pdf doc docx.
If your child does not have an e-mail address, please provide your own address.
Information about Additional Child
Enter information about child as it appears on the passport.
Files must be less than 2 MB.
Allowed file types: gif jpg png pdf doc docx.
If your child does not have an e-mail address, please provide your own.

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