Foreign National Information Form

ADVERTISEMENT

BRANDEIS UNIVERSITY
FOREIGN NATIONAL INFORMATION FORM FOR 2009
This form must be completed and returned to the Payroll Office before you may receive any form of payment from
Brandeis University. Please attach a copy of BOTH sides of your I-94 form “Arrival and Departure Record” (a
small white card inside your passport), a copy of your U.S. visa from your passport, and I-20 or IAP66. Failure to
return this form to the Payroll Office will result in withholding of all paychecks or payments to you from our Accounts
Payable Office until this form is completed and received by the Payroll Office at Bernstein-Marcus MS-110. Please call
Payroll at 6-4544 if you have any questions about this form.
Please print all information
1. I am a Brandeis University (check one)
___ Faculty Member
___ Student
____ Post Doc
____ Consultant
Department: __________________________________
2. Last or Family Name____________________________ First___________________________ Middle___________
Birth date: ___________________________________
3. U.S. Social Security Number ________-_____-___________ If you do not have a SSN, provide your ITIN Number
issued by the IRS ______________________.
4.U.S.Local Address
____________________________________________________________________________
No.
Street
____________________________________________________________________________
City/Town
State
Zip
5. Foreign Residence Address
__________________________________________________________________
Line 1
__________________________________________________________________
Line 2
__________________________________________________________________
Postal Code Province/Region
6. Country of Citizenship _______________________ 7. Country that issued Passport ________________________
8. Passport Number ________________________
9. Visa Number ____________________________________
(not the number that begins with a year)
10. Immigration Status (check one)
____ U.S. Immigrant/Permanent Resident (holder of a green card) STOP here, sign bottom of form on page 2 and
return to Payroll
____ J-1 Exchange Visitor (go to #11)
____ F-1 Student (skip to #12)
____ J-2 Spouse or Child of Exchange Visitor (skip to #12)
____ Other (please specify)_____________________________________ (skip to #12)
11. If Immigration Status is J-1, what is the subtype? (check one)
_____ (01) Student _____(02) Short Term Scholar _____ (05) Professor ______(12) Research Scholar _____Other
12. What is the actual primary purpose of the visit? (check one)
___ 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_________________________________________________________________
13. What is the actual date you entered the United States for this Primary Activity?
____/____/_______
month day year
14. What is the start date of your immigration status?
____/____/_______
month day year
15. What is the end date of your immigration status Primary Activity?
____/____/_______
month day year

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go
Page of 2