Foreign National Data Form

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FOREIGN NATIONAL DATA FORM
The Foreign National Information Form must be completed before you can receive any form of payment from the Payroll or
Accounts Payable departments. All applicable questions must be answered.
Last (Family) Name: _____________________________ First: ________________________ Middle: _____________________________
Social Security Number or Individual Taxpayer Identification Number: _____-___-_____ Visa No. ________________________________
Virginia Tech (Hokie) ID: ______________________ Date of transfer to Virginia Tech (if applicable) ______________________________
st
Date of very first (1
) time you ever arrived in the United States (US) for any purpose and Visa Type: ____ ______________________
Country of Citizenship: _____________________________
Country That Issued Passport: _________________________________
U.S. LOCAL ADDRESS:
FOREIGN RESIDENCE ADDRESS:
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
City:______________________________________________
City: _____________________________________________
State:____________________________ Zip:_____________
Province:_____________________________ Zip:__________
E-mail Address (VT preferred)
Country:_____________________ ______________________
Country of Tax Residence if Different From Foreign Residence Address: _________________________________________________
Did tax residency end?
Yes
No
If Yes, when ______/______/______
Month / Day / Year
INCOME PROVIDING ACTIVITY AT VIRGINIA TECH: (What is your occupation or generally describe the service you will performs)___
_____________________________________________________________________________________________________________________
FOR CONSULTANTS OR SELF-EMPLOYED INDIVIDUALS:
Do you or will you have an office (fixed base) in the United States?
Yes
No
If Yes, how many days in this tax year did you/will you have an office (fixed base)? __________________ days.
CURRENT IMMIGRATION STATUS:
U.S. Immigrant/Permanent Resident
J-1 Exchange Visitor
F-1 Student
H-1B Worker in Specialty Occupation
J-2 Dependent of Exchange Visitor (EAD Required)
OPT or
CPT
Other_____________________________
B1/B2 Visitor for Business/Tourism
WB/WT Visa Waiver Visitor for Business/Tourism (ESTA Program)
Days performing services at VT _______
Days performing services at VT _______
What is the Start Date of This Immigration Status (Issue date of visa)? ______/______/______
Month / Day / Year
IF F-1 VISA STATUS WHAT IS STUDENT TYPE? CHECK ONE:
Undergraduate
Masters
Doctoral
Other___________________________
Not Applicable
IF J-1/J-2 VISA STATUS, WHAT IS THE SUBTYPE? CHECK ONE:
Student
Professor
Research Scholar
Short Term Scholar
Other___________________________
WHAT IS THE ACTUAL PRIMARY ACTIVITY OF THE VISIT? CHECK ONE:
01 Studying in a degree program
05 Observing
08 Training
03 Teaching
06 Consulting
11 Temporary Employee
04 Lecturing
07 Conducting Research
12 Here with Spouse
15 Student Intern
What is the actual date you entered the United States for this primary activity? ______/______/______
Month / Day / Year
What is the end date of your immigration status’ primary activity?
______/______/______
Month / Day / Year
PLEASE COMPLETE THE REVERSE SIDE OF THIS FORM WITH YOUR VISA HISTORY AND SIGNATURE.
Revised 8/9/13

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