Given Name (First Name)*

Middle Name

Family Name (Last Name)*

What is the beneficiary’s gender? *

What is the beneficiary’s date of birth?

What is the beneficiary’s country of birth?

What is the beneficiary’s country of citizenship?

What is the beneficiary’s passport number?

Attached Copy of Passport

Does the beneficiary’s have a master’s or higher degree from a US institution of higher education such that the beneficiary is eligible for the advance degree exemption under INA?

YesNo

Attached Copy of Degree Certificate