H-1b Beneficiary Information Form

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Office of International Student and Scholar Services
International Studies and Programs
261 MSC, One University Boulevard
St. Louis, MO 63121
USA
Telephone 1.314.516.5229
Fax 1.314.516.5636
Email iss@umsl.edu
H-1B Beneficiary Information Form
Name exactly as written in passport:
Last (family) Name
First Name
Gender: ___ male
___ female
Date of Birth (m/d/y):
City and Country of Birth:
Country of Citizenship:
Social Security Number:
Passport Country of Issuance:
Passport Expiration Date:
Foreign Residential Address (required even if you are not presently living in your home country):
Current Address in the U.S.:
Tel:
(home)
(work) E-mail:
If you are outside the U.S., or if change of status cannot be granted from within the U.S., at what U.S.
Consulate (or port of entry if Canadian) would you apply for a visa?
If you are presently in the U.S.:
Current Immigration Status:
I-94 Number and Expiration Date:
Date of Most Recent Arrival in the U.S.:
Visa Expiration Date:
Have you ever been in J-1 status? __ Yes __ No
Are you subject to the section 212(e) - two-year home residency requirement? ___Yes ___ No
If yes, has the requirement been completed or waived? Please include details.
Has an immigrant petition (for permanent resident status) ever been filed on your behalf? ___ Yes ___No
If yes, please provide details, including date petition approved, denied, or whether currently
pending.
Have you ever been denied nonimmigrant (temporary) status in the U.S.? ___ Yes ___ No
If yes, please provide details.
an equal opportunity institution

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