Scholar Intake Information

Your Information

Name *

First name/Given name Last name/Family name/Surname

Personal Email *

Enter Email Confirm Email

Date of Birth *

Gender *

Female
Male
Other

Country of Citizenship *

Arrival Information

Date you arrived in the U.S. *

I-94 *

Please upload your I-94 here. You can access it at https://i94.cbp.dhs.gov/I94/. Click on “Get your most recent I-94” and enter the passport information that you used to enter the US. If you can’t find your I-94 please contact globalscholars@boisestate.edu.

Accepted file types: pdf, jpg, Max. file size: 10 MB.

Are you subject to 212(e)? *

If one or both of your Form DS-2019 or J1 visa stamp says you are subject to 212(e) Home Residency requirement, select Yes. If either your DS-2019 or J1 visa is marked “Not subject” or left blank, select No. If you are not sure, select Unsure.

Yes
No
Unsure

U.S. Contact Information

This information is put in the SEVIS immigration database, so it must be accurate at all times. If your U.S. address or phone number changes during your program, you are required to notify a scholar advisor within 10 days of the change so it can be updated in SEVIS.

Local Address in Idaho *

Provide the full address where you are currently living in Idaho.

Street Address Apt/Building City State ZIP Code

Mailing Address (if different)

If your U.S. mailing address is different from your local address above, please list the full address here.

Street Address Apt/Building City State ZIP Code

U.S. Phone Number *

Provide a U.S. telephone number where you can be reached. If you do not have a U.S. phone number, you may list your Boise State office/lab phone.

Boise State Department *

(i.e. Materials Science and Engineering, Communication, Education, etc.)

Host Faculty / Boise State Contact *

List the name of your Boise State host faculty or supervisor’s name.

Emergency Contact in Home Country

In case of an emergency, please list below who should be contacted in your home country.

Emergency Contact Name *

First name/Given name Last name/Family name/Surname

Relationship to you *

Phone Number *

List telephone number of emergency contact, including country code.

Email Address

List contact’s email address, if any.

Contact's Address *

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact in U.S.

In case of an emergency, please list who should be contacted in the United States.

Emergency Contact Name *

First name/Given name Last name/Family name/Surname

Relationship to you *

Phone Number *

List telephone number of emergency contact.

Email Address

List contact’s email address, if any.

Contact's Address *

Street Address Address Line 2 City State ZIP Code

Boise State Information

If you are an employee of Boise State you will have been assigned an ID number, email address, and Bronco Card by Human Resources. Please note that information below (if known). If you are not an employee, your host faculty/department will need to apply for “affiliate status” for you so you can receive an ID number, email address, and Bronco Card. If they have already done so, please note that information below.

To your knowledge, have you been assigned a Boise State ID number? *

Write No or Yes. If yes, please write in the number below.

To your knowledge, have you been assigned a Boise State email address? *

Write No or Yes. If yes, please write in your email address below.

Have you received a Bronco Card? *

Yes
No
It has been applied for, but I have not received it yet
I don’t know if it has been applied for

Have you made an appointment with a scholar advisor? *

If you haven’t yet, please email globalscholars@boisestate.edu to set up an appointment to check-in with a scholar advisor as soon as possible.

Yes, I have made a check-in appointment with a scholar advisor
No, but I will email globalscholars@boisestate.edu right after I submit this form

Do you have any questions for the scholar advisor? Please leave them here so we can gather information and give you the best advice possible during the check-in meeting.

By checking this box, I am stating that I received and will abide by the Pre-Arrival, Arrival and Orientation information provided to me on Boise State's J-1 website and/or applicable handouts. If I have any questions about any of this information I will contact a Scholar Advisor for help and clarification. *

I agree to the above statement.

Scholar Intake Information

Your Information

Arrival Information

U.S. Contact Information

Emergency Contact in Home Country

Emergency Contact in U.S.

Boise State Information

International Faculty and Visiting Scholars