Saturday, June 15, 2019
SP16-F-1 OPT Student Form Type 3-20150824
F-1 OPT Student Form
(Student Type 3)
Directions
You are currently on OPT or in your OPT grace period.
Please ll out all of the following information and attach all of the requested documents. Remember
that the asterisk (*) next to a eld means that it is required.
For e cient processing of your request, please:
Submit all documents in English or with a true English translation made from the original
document written in the foreign language. This can be done either by a professional translation
done through a licensed translation service, or can be done by someone who is competent in
both the foreign language and in English. In the case of the latter, the person should certify this
with the following language:
"I certify that I am competent to read and translate in and in English, and I certify that the
translation performed above is a true translation taken from the original document written
in." NAME, ADDRESS, DATE
Submit all documents in PDF format.
Include your ITU Student ID Number in the title of all submitted documents
Please provide your full name as it appears in your passport.
Lead Source
Surname/Primary Name
ISO Type 3
Sakaguchi
Lead Status
Automated
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Student ID Number
OPT EAD Card Expiration Date
94894
8/12/2019
Given Name
Name of Last Designated School O cial who
signed your I-20
Yu
Program of Study
Master of Business Administration
Sarah Brockmeyer
Are you currently on OPT?
Yes
Date of Birth
Sunday, January 8, 1989
Gender
Male
Country of Birth
Japan
Country of Citizenship
Japan
E-mail Address
yusakaguchi108@gmail.com
Permanent Address Outside U.S.
Higashitamagawa 2-15-21
Setagaya, Tokyo, 1580084
Japan
Local Address in U.S.
650 E Capitol Avenue, 493
Milpitas, California, 95035
United States
Phone Outside the U.S.
0337205083
Phone Within the U.S.
(408) 6018575
Anticipated Academic Enrollment Term
Fall 2019
Name of Last University Attended
Santa Clara University
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Please return to the ISO Submission Form and select a student type that better
matches your current status.
Are you currently out of status and need to be
reinstated?
No
Upload Copy of Your Passport *
passport.pdf
Upload Copy of Your Current U.S. Visa or I797A *
F-1Visa.pdf
Upload I-94 *
I-94.pdf
Upload your most recent I-20 from your
current school *
I-20.pdf
Upload OPT EAD Card *
EAD card.pdf
Do you have any dependents who are or will be
joining you in the U.S. and need an F-2 I-20?
No
Please submit the F-2 Request Form by submitting a request through the ITU Support System to the
International Student O ce.
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Estimated Cost of Attendance for Current ITU Programs for F-1 Students
Tuition and Fees (based on 27 credit hours – 12 month period)**
$17,070
Living Expenses (housing, meals)
$18,707
Expenses for Dependents (per dependent, if applicable)
$15,000
Other personal expenses
$2,100
TOTAL
$37,877
TOTAL With One Dependent (add $15,000 per additional dependent)
$52,877
If you have dependents, you must provide proof of additional funding for each dependent. Add $15,000
for each dependent. Do not include dependents who were born in the US or who hold US passports. **
The tuition and fees listed in the table above are effective until the end of the Summer 2017 term.
Effective Fall 2017, tuition will increase for all students by $50/credit hour (from $550 to $600).
Sources of Financial Support (Check all that
apply) *
Upload signed A davit of Support
a davit of support.pdf
Funding from Parent, Relative, or Private
Sponsor
Upload bank statement(s)/letter(s) clearly
showing account holder's name and current
balance of funds
Bank1&2&3.pdf
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Download A davit of Support form.
All students transferring into ITU will be able to pick up their I-20 at mandatory New Student
Orientation.
Signature
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