FOREIGN ADDRESS IN YOUR COUNTRY OF PERMANENT RESIDENCE

Please DO NOT use a United States address in this section. Please only use English.

Street Address Line 1

Address Line 2

Address Line 3

Address Line 4

City

State/Province/Region

Postal Zip Code

Country

Is the above address where you would like your MCPHS University I-20 sent?

YesNo

Please list where you would like the I-20 sent:

MCPHS will start to send I-20’s out starting 3 months prior to the start of a term.

Street Address Line 1

Address Line 2

Address Line 3

Address Line 4

City

State/Province/Region

Postal Zip Code

Country

International Country Code

Include your country calling code; for example, 91 for India.

International Phone Number

NOTE: This cannot be a U.S. phone number.

CERTIFICATION

I certify that all the information I have given in this application is complete and accurate.

I Agree

I certify that I am aware of the costs of attending MCPHS University and I am ultimately responsible for all yearly expenses for the entire length of my stay in the United States.

I Agree

I understand that by submitting this request, in addition to receiving my MCPHS I-20, I must apply for an F-1 visa, unless a citizen of Canada or Bermuda, or I am currently in F-1 status.

I Agree

I understand that any misrepresentation on this form is cause for refusing or revoking admission to the University.

I Agree