Nra 001 Foreign National Information Form
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1
2North Carolina
Foreign Visitor Information Form
This form must be completed before you can receive any form of payment. All applicable questions below must be answered. The
following documents must be attached to this completed form: 1. copy of Passport; 2. copy of Visa; 3. copy of I-94 Departure
Record; 4. copy of Social Security card or ITIN card; 5. copy of Form I-20 or Form IAP66/DS2019.
PERSONAL / PASSPORT INFORMATION
Last or Family Name: ________________________
First: _________________
Middle: ____________________
U. S. Social Security No. or Individual Taxpayer Identification No.: _________________
Date of Birth : ____/____/_____
month/ day/ year
Employer:
E-mail address: __________________________________
__________________________
U. S. Telephone No.: (Work)____________________
U. S. Telephone No.: (Home)________________________
Country of citizenship: _________________________
Country that issued passport: _______________________
Passport No.: _______________________
Passport Expiration Date: ____/____/____
month/ day/ year
Visa No.: (control number in upper right corner of stamp in passport): ______________________
ADDRESSES
U.S. Local Street Address:
Foreign (home) Residence Address (should not be P.O. Box)
_______________________________________________
________________________________________________________
Street
Street
_______________________________________________
________________________________________________________
City
City
Province / State
Postal Code
_______________________________________________
________________________________________________________
State
Zip Code
Country
CURRENT IMMIGRATION STATUS
[ ] OTHER
: _____________
[ ] U.S. Immigrant/Permanent Resident
[ ] F-1 Student
[ ] H-1B Temporary Worker
[ ] J-2 Dependent
[ ] DACA
[ ] J-1 Exchange Visitor
--IF J-1 Exchange Visitor, what category?
[ ] Student
[ ]Professor
[ ] Research Scholar
[ ] Short Term Scholar
[ ] Other: __________________
PRIMARY ACTIVITY DURING THIS VISIT (Choose only one)
[ ] Studying in a degree program
[ ]
[ ] Demonstrating special skills
[ ] Studying in a non-degree program
[ ] Consulting
[ ] Clinical activities
[ ] Teaching
[ ] Conducting research
[ ] Temporary employment
[ ] Lecturing
[ ] Training
[ ] Here with spouse
What is the date you first entered the United States? Please estimate if unknown.
_____/ ____/ _____
(This date is the first trip you ever made to the United States)
month/ day/ year
What was the start date of your immigration status for the current activity?
_____/____/______
(This date is stamped on your visa and I-94 Departure Record)
month/ day/ year
What is the projected end date of your primary activity?
_____/____/ ______
(In many cases, this is the completion date on your immigration document.)
month/ day/ year
If you are a student, at what level do you study?
[ ] Undergraduate
[ ] Masters
[ ] Doctoral
[ ] Other: ________________
Form NRA 001
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