F' ' 'l,Times .''+#I-20 Request Form `% (p Financial Support * Source Name )8,(Personal/Parent/Other sponsor/Scholarships)) )( Relationship)h Amount in US$ ( 1.) \ ____________________________________________ ________________________ _________________( 2.) \ ____________________________________________ ________________________ _________________( 3.) \ ____________________________________________ ________________________ _________________( 4.) \ ____________________________________________ ________________________ _________________( 5. )   )fIf you were awarded a Berklee scholarship, indicate amount here. Submit copy of scholarship letter.  ( _________________ ( * submit Affidavit of Support )qand) < bank/or other relevant financial statement from each source(  )Total ) _________________ S  (Permanent Address )w )(Outside the United States)(9(you will be using this address in your visa application)   *Street: )(________________________________________( , ___________________________________________ *City: )(________________________________________ (4Province:  )I __________________ /____________ +#5 Postal Code No.(ICountry: )"#___________________________________ )___ '48% 9$ (DPassport Information * 2This section must match your passport data exactly* 2Submit photocopy of your passport (name page only) * Family name  )H#___________________________________ (mp (y  ( First name )H_ )"__________________________________ (pGender )! ) Male) Female (  (Country of Birth _ )a_______________________________ (pDate )$ )Month ) _________________(p  )of(Passport Issuing Country _ )________________________ )Birth )$ )Day ) __ __ )*Year ) ) __ __ __ __    ( 2Do you wish to add dependents to your I-20? _____ * ;Spouse and children only. Details on visa-information page *CDo you currently have an F-1 (student) visa in your passport? _____*QDo you plan to attend another school in the United States prior to Berklee? _____ *(__________________________)______________)l  )Phone: ) _____________________________ (1 Signature)date +H  )E-mail: ) _____________________________ffffff '  DV]'HffffffD'HffffffD'H  (__ ) aPLEASE RETAIN COPIES OF ALL FINANCIAL DOCUMENTS AS YOU WILL NEED THEM FOR YOUR VISA APPLICATION__ ( M Berklee College of Music, 1140 Boylston Street, Boston, MA 02215-3693, USA. (Y&Phone: 617-747-2222 Fax: 617-747-2047 S% (Mailing Address for I-20  )If different from Permanent Add (COURIER MAIL REQUIRES)i Ph. No: ) ___________________________ (Street: ))_________________________________________( - ____________________________________________ *City: ))_________________________________________ (4Province:  )I!___________________ /____________ +#5 Postal Code No.(ICountry: )"#___________________________________ )____ 'D~HD~H0