Foreign National Information Form Page 2
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2BRANDEIS UNIVERSITY
FOREIGN NATIONAL INFORMATION FORM FOR 2009
Page 2
16. If you are not a student, describe in general the service you will perform (e.g. “Professor of Chemistry.”)
17. If you are a student check off the type of student you are:
____ Undergraduate
____Masters
_____ Doctoral ____
Other (please specify)______________________
18. Are you married? __ Yes __ No
Is your spouse in the U.S.? __ Yes__No
Number of Dependants _____
19. For Consultants/Self Employed Individuals: Do you/will you have a fixed office (fixed base) in the USA? _______
If yes, how many tax days in this year did you/will you have an office? This includes any office at any location.
Number of days____________
20. Country of Residence if different from foreign address (other than your U.S address) ________________________
Did tax residency end? ____Yes _____No
If yes, when? ______/_____/_______
month day
year
21. Please list any Visa immigration activity in the last three calendar years and all F, J, M or Q Visas
since 1/1/1985. Use the “key” below to complete Visa Immigration Status, J-1 Subtype and Primary
Activity columns.
Date of Entry
Date of Exit
Visa Immigration Status
J-1 Subtype
Primary Activity
Have You Taken Any
Treaty Benefits
___ / ___ /___
___ / ___ /___
____________________
____________
________________
() Yes () No
___ / ___ /___
___ / ___ /___
____________________
____________
________________
() Yes () No
___ / ___ /___
___ / ___ /___
____________________
____________
________________
() Yes () No
___ / ___ /___
___ / ___ /___
____________________
____________
________________
() Yes () No
___ / ___ /___
___ / ___ /___
____________________
____________
________________
() Yes () No
Key
VISA IMMIGRATION STATUS:
U.S. Immigrant/ Permanent Resident
F-1
Student
Spouse of child of Exchange
H-1 Temporary Employee
Visitor J-1 Exchange
Visitor
Other (please specify)_____________________________________________________
J-1 Subtype
01 Student
02 Short Term Scholar
05 Professor
12 Research Scholar
Other (please specify)____________________________________
PRIMARY PURPOSE:
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 information provided is true and correct. I understand that if my status changes from that
which I have indicated on this form, I must submit a new Foreign National Information Form to the Payroll
Department.
Signature__________________________________________________________Date________________
E-mail address: _______________________________________ Phone number: ___________________
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