Non-Resident Alien 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 1/1/85
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
______/______/______ ______/______/______
Yes
No
______/______/______ ______/______/______
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:
PRIMARY PURPOSE:
05 - Observing
09 - Demonstrating Special Skills
01 - Studying in a degree program
06 - Consulting
10 - Clinical Activities
02 - Studying in a Non-Degree program
03 - Teaching
07 - Conducting Research
11 - Temporary Employee
08 - Training
12 - Here with Spouse
04 - Lecturing
99 - Other, please specify:
I hereby ceritfy that all of the above information is true and correct. I understand that if my status changes from that which I have indcated
on this form I must submit a new Foreign National Information Form to the Payroll Department.
Signature:
Date:
HOW TO COMPLETE THE FOREIGN NATIONAL INFORMATION FORM:
1. Name: List full name
2. Social Security Number: Enter US social security number issued by the US Social Security Administration not your ID number.
3. ID#: Enter your Employee/Student/Faculty Identification Number.
4. Local Street Address: List your local US address.
5. Residence: List your non US address.
6. Country of Citizenship(s).
7. Country that Issued Passport: List Country in which you were issued your passport. Not the country where it was issued.
8. Passport #: Enter your passport number.
9. Visa #: Enter your Visa number.
10. Immigration Status: Check yes or no. If yes, complete the above form for the time you were present in the United States.
11. Immigration Status Check the type of immigration status that you currently hold. If you check U.S. Immigrant/Permanent
12. Immigration Status for J-1: Check the appropriate J-1 subtype.
13. Actual Primary Activity: Check one activity.
14. Actual Entry Date into the United States: Must include month, day, and year. Approximate if you do not know.
15. Start Date: Must include month, day and year. Approximate if you do not know.
16. End Date: Must include month, day, and year. Approximate if you do not know.
17. Occupation: Describe in general the service you will perform.
18. Check the appropriate box
19. Is your spouse in the USA?: Check the appropriate box. Give number of other dependents in the USA.
20. Tax residence is where you last paid taxes as a resident and can be different from legal residence. Do not include the USA.
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