Foreign National Information Form
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1
2FOREIGN NATIONAL INFORMATION FORM (PAGE 1)
The Foreign National Information Form MUST be completed and returned before you can receive any form of payment.
All applicable questions below must be answered. A copy of: both sides of your 1-94 Form, your US VISA from your passport, the picture page of
your passport, and an 1-20 or DS2019 form must be submitted with this form.
Instructions on next page.
Instructions on reverse.
(1) Last or Family Name
First
Middle
(3) ID #: ________________________________________________
(2) Social Security #
Local Phone # :___________________Work Phone#_____________________
Email Address:_________________________
(4) U.S. LOCAL ADDRESS:
(5) FOREIGN RESIDENCE ADDRESS:
(4)
(5) Address line 1:
(4)
(5) Address line 2:
(4)
(5) Address line 3/City:
(4) City:
(5) Postal Code:
Province/Region:
(4) State:
Zip Code:
(5) Foreign County:
(6) Country of Citizenship:
(7) County that Issued Passport:
(9) Visa #:
(8) Passport #:
(not the Control # that begins with a year)
(10) Have you ever had previous immigration status in the United States? Yes
No
If yes, see page 2.
(11) IMMIGRATION STATUS:
(12) IF IMMIGRATIONS STATUS IS J-1,
(13) WHAT IS THE PRIMARY
WHAT IS THE SUBTYPE?
ACTIVITY OF THE VISIT?
01
Studying in a Degree Program
U.S. Immigrant / Permanent Alien
01 Student
02
Studying in a Non-Degree Program
F-1
Student
05 Professor
03
Teaching
J-2
Spouse or Child of Exchange Visitor
12 Research Scholar
04
Lecturing
J-1
Exchange Visitor
02 Short Term Scholar
05
Observing
H-1
Temporary Employee
Other _____________________________
06
Consulting
O-2
Personnel Accompanying O-1 Alien
07
Conducting Research
O-1 Alien of Extraordinary Arts Ability
08
Training
P-1 Int’l. Renowned Performing Group
09
Demonstrating Special Skills
P-3 Culturally Unique Performers/Groups
Other _____________________________
10
Clinical Activities
11
Temporary Employee
12
Here with Spouse
(14) WHAT IS THE START DATE OF
(15) WHAT IS THE ACTUAL DATE
(16) WHAT IS THE PROJECTED END
YOUR IMMIGRATION STATUS
YOU ENTERED THE U.S.A.?
DATE OF YOUR IMMIGRATION
FOR THIS PRIMARY ACTIVITY?
STATUS FOR THIS ACTIVITY?
_____/ _____ /_____
_____/ _____ /_____
Month
Day
Year
_____/ _____ /_____
Month
Day
Year
Month
Day
Year
(17) INCOME PROVIDING ACTIVITY
(18) IF A STUDENT, WHAT TYPE?
(19) SPOUSE IN U.S.A.?
(e.g. Professor of Chemistry)?
Yes
No
Undergraduate
Masters
No. of dependents ___________
Doctoral
Other ___________
------------------------------------------------------
(20) FOR CONSULTANTS/SELF EMPLOYED INDIVIDUALS:
(21) COUNTRY OF TAX RESIDENCE IF DIFFERENT FROM
Do you/will you have an office (fixed base) in the U.S.A.?
FOREIGN RESIDENCE ADDRESS: _________________________
Yes
No
If yes, how many days in this tax year will you have
the office (fixed base?) No. of Days: _____________
Did tax residency end?
Yes
No If yes, when? ____/ ____ /____
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