H-1b Beneficiary Intake Form Page 2
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412. Address in Home Country/Country of Permanent Residence:
Address 1
City
Province/State
Postal Code
Country
13. U.S. Home Address (if currently in the U.S.):
Address 1
City
State
Zip Code
If you live in any state other than CT, do you commute to UConn from there?
Yes
No
If not, explain:
14. Current Home Phone #: (______)_________________________
15. Work Phone # in the U.S.: (______)_________________________
16. Email:
17. Passport: Country of Issuance
Passport #:
Date Passport Issued (mm/dd/yyyy):
Expiration Date of Passport (mm/dd/yyyy):
18. Student & Exchange Visitor Information System (SEVIS) Number, if any: __________________________
19. Employment Authorization Document (EAD) Number, if any: _____________________________
20. USCIS “A”number (“A” followed by nine(9) digits), if any:______________________________________
21. Highest Level of Education (Please check only one box):
□
Bachelor’s degree (for example: BA, AB, BS)
□
Master’s degree (for example: MA, MS, MEng, MEd, MSW, MBA)
□
Professional degree (for example: MD, DDS, DVM, LLB, JD)
□
Doctorate degree (for example: PhD, EdD)
22. Major/Primary Field of Study
23. Please provide a summary of your CURRENT job description (for the job title/occupation provided in the above #11):
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