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Immigration Form

Personal Information

Please make sure all uploaded documents are visibly clear and in color*

Name*
Please select a gender*
Current Address*
Is your current address the same as your permanent address?*
Permanent Address*

Passport Information

Please make sure all uploaded documents are visibly clear and in color*

Full Name as it appears on your Passport (If you do not have a Middle Name, please write N/A)*
Please upload a color copy of your Passport. Include all pages (from front cover to back cover) This should be done as a single PDF document
No File Chosen
File uploads may not work on some mobile devices.
Date of Issue*
Date of Expiration*
Date of Birth*
Marital Status*
If married, do you have a copy of the marriage certificate*
If yes, please upload a copy of your marriage certificate
No File Chosen
File uploads may not work on some mobile devices.
If no, can you obtain a copy of your marriage certificate?
If married, did you legally change your name?*
If divorced, do you have a copy of the divorce certificate*
If yes, please upload a copy of your divorce certificate
No File Chosen
File uploads may not work on some mobile devices.
If no, can you obtain a copy of your divorce certificate?
If divorced, did you legally change your name?*
If widowed, do you have a copy of the death certificate*
If yes, please upload a copy of the death certificate
No File Chosen
File uploads may not work on some mobile devices.
If no, can you obtain a copy of the death certificate?
If widowed, did you legally change your name?*

Citizenship Information

Please make sure all uploaded documents are visibly clear and in color*

Are you a United States citizen?*
If yes, were you born in the United States?*
If yes, do you have a copy of your Birth Certificate*
If yes, please upload a copy of your Birth Certificate*
No File Chosen
File uploads may not work on some mobile devices.
If no, can you obtain a copy of your Birth Certificate?*
Please upload a copy of your original United States Naturalization Certificate*
No File Chosen
File uploads may not work on some mobile devices.
Do you have a copy of your Birth Certificate?*
If yes, please upload a copy of your Birth Certificate*
No File Chosen
File uploads may not work on some mobile devices.
If no, can you obtain a copy of your Birth Certificate?*
If no, are you a legal permanent resident of the United States (Do you hold a Green Card)?*
If yes, please upload a copy of your legal Permanent Residency card:*
No File Chosen
File uploads may not work on some mobile devices.
If yes, do you have a copy of your Birth Certificate?*
If yes, please upload a copy of your Birth Certificate*
No File Chosen
File uploads may not work on some mobile devices.
If no, can you obtain a copy of your Birth Certificate?*
If no, are you a Canadian citizen?*
If yes, were you born in Canada?*
If yes, do you have a copy of your Birth Certificate?*
If yes, please upload a copy of your Birth Certificate*
No File Chosen
File uploads may not work on some mobile devices.
If no, can you obtain a copy of your Birth Certificate?*
Do you have a copy of your Birth Certificate?*
If no, can you obtain a copy of your Birth Certificate?*
Are you a permanent resident of Canada?*
If yes, please upload your Canadian Permanent Residency card:*
No File Chosen
File uploads may not work on some mobile devices.
Do you have a copy of your Birth Certificate?*
If you, can you obtain a copy of your Birth Certificate?*
If yes, please upload a copy of your Birth Certificate*
No File Chosen
File uploads may not work on some mobile devices.
Can you obtain a copy of your Birth Certificate?*
If yes, please upload a copy of your Birth Certificate*
No File Chosen
File uploads may not work on some mobile devices.
If you're not a United States citizen or Canadian citizen, please select what type of Visa you hold, if any, of the following:
Please upload a copy of your Visa
No File Chosen
File uploads may not work on some mobile devices.
Visa Expiration Date

Address Information

Please make sure all uploaded documents are visibly clear and in color*

Have you lived in the same address for the past 5 years? (You could use the address that your current Driver's License or State ID shows):*
If yes, please provide the address:*
Does your Drivers License show the address entered above?*
If yes, please upload a copy of your Drivers License*
No File Chosen
File uploads may not work on some mobile devices.
If no, please list all your addresses and dates you lived there for in the past 5 years:*
If no, please list all your addresses and dates you lived there for in the past 5 years:
If no, please list all your addresses and dates you lived there for in the past 5 years:
Have you ever used any other names? (Please include Maiden name if you are married and legally changed your name) Yes/No:*
If yes, please list them below:*
If yes, please list them below:
If yes, please list them below:

Additional Information

Have you ever been convicted of a felony or misdemeanor?*
You will be required to submit a Police Clearance for your Student Permit process in Aruba.
Do you have any pending felony or misdemeanors?*
You will be required to submit a Police Clearance for your Student Permit process in Aruba.

Additional Information

Terms and Conditions

Please submit this completed and signed Immigration form. In addition to this form, please make sure you submitted your immigration fee if you have not already. We will not process any documents until this form and the immigration fee have been submitted. You will receive a confirmation email with further instructions. Thank you again for your interest and pursuit of your education at Xavier University School of Medicine.

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