Foreign National Information Form (Page 1)
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2F O R E I G N N A T I O N A L I N F O R M A T I O N F O R M ( P A G E 1 )
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N e w
R e h i r e
A n n u a l U p d a t e
C h a n g e i n V i s a S t a t u s
The Foreign National Information Form must be completed before you can receive any form of payment.
All applicable questions below must be answered. A copy of both sides of your I-94 Form “Arrival and Departure Record”, (a
small white card inside your passport), copy of Passport pages showing name, number and photo, copy of U.S. VISA, and
Form I-20, DS-2019, or I-797 must be attached to this form.
(1) Last or Family Name: ________________________________First:__________________________ Middle: ________________
(2) Social Security or ITIN #:______________________________
(3) Local Telephone #: __________________________________Email Address: _________________________________________
(4) U. S. LOCAL ADDRESS: _________________________
(5) FOREIGN RESIDENCE ADDRESS:_________________
_________________________________________________
________________________________________________
(4) Address Line 2: _________________________________
(5) Address Line 2:_________________________________
(4) Address Line 3: _________________________________
(5) Address Line 3/City:_____________________________
(4) City: __________________________________________
(5) Postal Code:____________Province/Region:_________
(4) State: _______________________ Zip: ______________
(5) Foreign Country:_______________________________
(6) Country of Citizenship: ________________________________(7) Country That Issued Passport: __________________________ ___
(8) Passport #: _________________________________________(9) USA Visa # (RED NUMBER): ______________________________
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(10) Have you ever had another immigration status in the United States?
Yes
No (If yes, complete Q# 23 on page 2)
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(11) MY CURRENT IMMIGRATION STATUS IS:
F-1 Student
F-1 Student (on OPT or CPT)
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U.S. Immigrant/Permanent Resident
WB/WT Visa Waiver
B-1 Business/B-2 Tourist Visa
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J-1 Exchange Visitor (If yes, do step 13.)
H-1B Temporary Employee
E-3 Visa
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J-2 Spouse or Child of Exchange Visitor
O-1 Visa Individual
Other: __________________________
(12) WHAT IS THE PRIMARY ACTIVITY OF THIS VISIT? CHECK ONLY ONE:
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01 Studying in a Degree Program
06 Consulting
11 Temporary Employee
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02 Studying in a Non-Degree Program
07 Conducting Research
12 Here with Spouse
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03 Teaching
08 Training
13 Other: _________________________
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04 Lecturing
09 Demonstrating Special Skills
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05 Observing
10 Clinical Activities
(13) IF A J-1 VISA IMMIGRATION STATUS , WHAT IS THE SUBTYPE? CHECK ONLY ONE:
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01 Student
02 Short Term Scholar
05 Professor
12 Research Scholar
Other: __________________________
(14) WHAT IS THE ACTUAL DATE YOU
(
15 & 16) WHAT IS THE START AND END DATE OF YOUR IMMIGRATION STATUS
FIRST ENTERED THE UNITED STATES?
FOR THIS PRIMARY ACTIVITY (AS NOTED ON FORMS I-20, I-94, DS-2019, OR I-797)?
(VERY FIRST DATE, ANY STATUS)
___/___/___
___/___/___
___/___/___
(15) START DATE:
(16) END DATE:
Month Day Year
Month Day Year
Month Day Year
(17) U.S. INCOME ACTIVITY PAYING YOU (WHAT IS YOUR OCCUPATION OR DESCRIBE THE SERVICE YOU WILL PERFORM):
_________________________________________________________________________________________________________
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Have you worked on campus before?
Yes
No
Do you currently have another job(s) on campus?
Yes
No
(If Yes, LIST below (a) job title, (b) name of the department and employer (Foundation, ASI, or CSUF) (c) hours work, and (d) start date)
________________________________________________________________________________________________
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(18) IF STUDENT, WHAT TYPE?:
Undergraduate
Masters
Doctoral
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(19) MARTIAL STATUS: Married?
Yes
No Is your spouse in the U.S:
Yes
No NUMBER OF DEPENDENTS IN U,S _____
(20) FOR CONSULTANTS/SELF EMPLOYED INDIVIDUALS:
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Do you/will you have an office (fixed base) in the USA?
Yes
No If yes, how many days in this tax year)? __________ Days
(21) COUNTRY OF TAX RESIDENCE (If different from country noted in foreign address above): _______________________
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__/__/__ (
Did your tax residency end prior to this visit in the U.S.?
Yes
No
If YES, what date?
Month/Day/Year)
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