Preliminary Information To Determine Eligibility For Permanent Residence Form

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Preliminary Information to Determine Eligibility for Permanent Residence
Complete and return this form to International Education Services, with Department Chair's Signature.
Alien's Name ______________________________ Date of Birth __________ Birth Place ________________
Country of Citizenship ______________________ Country of Permanent Residence ____________________
Name of Spouse (if any) _____________________________________ Birth Place ______________________
Alien's Current Address ____________________________________________________________________
___________________________________________ Phone ___________________
Alien's Email Address
____________________________________________________________________
Date of Initial (or Anticipated) Arrival in United States _____________________________________________
Date of Last Entry in U.S. _________________ Visa Type _______________ Expiration Date ____________
Current Visa Type ________________________________________________ Expiration Date ____________
Comments: Extensions of Stay Approved by INS _______________ to ______________
_______________ to ______________
_______________ to ______________
Former Visas Obtained (Specify type) __________________________________________________________
Last Professional Position ____________________________________________________________________
Title of Proposed UMCP Position ______________________________________________________________
Full- or Part-time?
Full-time
Part-time
Salary ___________________ (for _____ months per year)
How long has this position existed? ____________________________________________________________
Is it one which will be filled on a continuing basis?________________________________________________
Is it dependent on a specific grant or program for funding? __________________________________________
If so, indicate: Duration of funding _______________________________________________________
a) Will position cease to exist if funding is terminated? ______________________________________
b) If position is terminated, will alien be offered continued employment? ________________________
Does position involve any teaching responsibilities? _______________________________________________
Has the alien ever been previously employed in the U.S.? ___________________________________________
In the same department? ______________ In the same position? _______________ On what visa? _________
Describe specific professional skills and experiences of alien which qualify him/her above other applicants.
Date by which department hopes alien will begin employment _______________________________________
IES Rev. 6/03 preinfo4pr.doc Page 1 of 2

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