Non-Resident Alien Information Form Page 2
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VISA DETAIL
Fill in the Visa and Immigration status for each of the last 7 years.
Visa
Visa Number
PRIMARY reason
Date Arrived in U.S.
Left U.S. (or
J1 Subtype
Type
for entering the
expected departure
U.S. (use code
date)
below)
Current Visa:
Prior Visa:
Prior Visa:
Prior Visa:
Primary Activity Codes:
01 Studying Degree Program
08 Acquire Training
15 Supporting an artist / athlete
02 Studying Non Degree Program 09 Demonstrating Special Skills
16 Tourist
03 Teaching
10 Clinical Activities
17 Business Activities
04 Lecturing
11 Temporary Employment
18 Board of Director Activities
05 Observing
12 Here with Spouse or Relative
19 Practical Training / J-1 F-1
06 Consulting
13 Performing as an artist
20 Educational/ Professional Activities
07 Conducting Research
14 Performing as an Athlete
21 Summer Travel Work
J-1 Subtypes
01 Student
06 Specialist
11 Trainee Medical
02 Short Term Scholar
07 Alien Physician
12 Research Scholar
03 Trainee- Non-Medical
08 Other - International Visitor
13 Summer Travel/ Work
04 Teacher
09 Other - Alien of the
99 Not Applicable
05 Professor
10 Other - Camp Counselor
(Payroll Information Only: Run Substantial Presence Test)
ATTACHMENTS
Before this form can be processed, you must attach copies of the following.
Passport (Page 1 only showing your identification and passport number)
Visa (Attach copies of your U.S. Visa plus pages clearly showing entry and exit dates)
Form I-94 showing current Immigration Status and duration of stay. Copy front and back.
Form I-20-ID Certification of Eligibility of Non-immigration (F-1) Student
Or IAP66 Certification of Eligibility for Exchange visitor (J-1) Status.
Remember to bring your visa with you when submitting this form in case there are any questions.
AUTHORIZATION
Under penalties of perjury, I certify that the above information is true and correct.
Sign___________________________________________ Date__________________
Before submitting this form, PLEASE REVIEW:
Did you complete each item and fill in all the blanks? Incomplete forms cannot be processed.
Did you attach the required documents?
Do you have your visa with you when submitting this form to payroll? (Rocket Hall room 1700)
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