Foreign National Information Form Page 2
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2FOREIGN NATIONAL INFORMATION FORM (Page 2)
The Foreign National Information Form must be completed before you can receive any form of payment
Please list any VISA immigration activity in last three calendar years and all F, J, M or Q VISAS since January 01, 1985:
Date of Entry
Date of Exit
VISA Immigration Status
J-1 Subtype
Primary Activity
Have you taken any
Treaty Benefits
____/____/____
____/____/____
___________________________
______________
___________________
Yes
No
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___________________________
______________
___________________
Yes
No
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____/____/____
___________________________
______________
___________________
Yes
No
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____/____/____
___________________________
______________
___________________
Yes
No
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___________________________
______________
___________________
Yes
No
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___________________________
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___________________
Yes
No
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___________________________
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___________________
Yes
No
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Yes
No
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Yes
No
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___________________________
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Yes
No
VISA Immigration Status:
U.S. Immigrant/Permanent Resident
F-1 Student
J-2 Spouse or child of Exchange Visitor
J-1 Exchange Visitor
H-1 Temporary Employee
Other: ___________________________________________________________________________________________________________________________
J-1 Subtype
01 Student
05 Professor
12 Research Scholar
02 Short term scholar
Other __________________________________________________________________________________
Primary Activity:
01 Studying in a degree program
05 Observing
09 Demonstrating Special Skills
02 Studying in a Non-Degree Program
06 Consulting
10 Clinical Activities
03 Teaching
07 Conducting Research
11 Temporary Employee
04 Lecturing
08 Training
12 Here with Spouse
99 Other, Please specify: _______________________________________________________________________________________________________________
I hereby certify that all of the above information is true and correct.
Signature: ___________________________________________________________________________________ Date: ___________________________
HOW TO COMPLETE THE FOREIGN NATIONAL INFORMATION FORM:
1.
Name: List full name.
currently hold. If you check U.S. Immigrant/Permanent Resident,
2.
Social Security Number. Enter US social security number issued by
holder of a “green” card, you may proceed to the bottom of the form
The US Social Security Administration not your ID number. Do not
Sign and date.
List numbers not assigned by the United States Social Security,
11. Immigration Status for J-1: Check the appropriate J-1 subtype.
i.e. Canadian social security number. All employees must have a
12. Actual Primary Activity: Check one activity.
social security number in order to work. If none enter your ITIN issued
13. Actual Entry Date into the United States: Must include month, day,
by the IRS.
and year. Approximate if you don’t know.
3.
Local Street Address: List your local US address.
14. Start Date: Must include month, day, and year. Approximate if you
4.
Residence: List your non-US address.
don’t know.
5.
Country of Citizenship(s).
15. End date: Must include month, day and year. Approximate if you
6.
Country that Issued Passport: List Country in which you were issued
don’t know.
your passport. Not the country where it was issued.
16. Occupation: Describe in general the service you will perform.
7.
Passport #: Enter your passport number.
17. Check the appropriate box.
8.
VISA #: Enter your VISA number
18. Is your spouse in the USA?: Check the appropriate box. Give number
9.
Immigration Status: Check yes or no. If yes, complete the above form
of other dependents in the USA?
For the time you were present in the United States. Approximate if
19. Consultants/Self-Employed Individuals: Check the appropriate box. This
You don’t know.
includes any office at any location specifically identified with you.
10. Immigration Status: Check the type of immigration status that you
20. Tax residence is where you last paid taxes as a resident and can be
Different from legal residence. Do not include the USA.
May be reproduced with permission.
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