The Foreign National Information
Form must be completed before you can receive any form of payment. All applicable questions must be
answered. A copy of both sides of you
I-94 Form, “Arrival and Departure Record” (a small white card inside your
passport), copy of your U.S. VISA from your passport, and I-20 or IAP66 must be
attached to this form. This form must
be returned before any check can be issued by the Payroll or Accounts Payable
Department and must also be completed by anyone receiving tuition
remission/scholarship.
Last or Family Name: ____________________________________________________________________________________
First Name: ____________________________________ Middle
Name: ____________________________________
U. S. Local Address: ____________________________________________________________________________________
City: ____________________________________ State: ________________________
Zip: ___________________
County of Residence Address: _____________________________________________________________________________
City: __________________________________________ Postal Code: _______________________________________
Province Region: ____________________________________ Home Country: ________________________________
Country of Citizenship: _____________________________ Country the Issued Passport: _________________________
Passport #: ___________________________________________ Passport Expiration: _____ /_____ /_____
month day
year
Visa #: __________________________________________ Social Security #: ____________________________________
University ID #: _________________________________________ Gender: ____________________________________
Occupation in U.S.: ______________________________________ Department: _________________________________
Date of employment in U.S.: _____
/_____ /_____ Date of
Birth: _____ /_____ /_____
month day year month day
year
Current Immigration Status:
ٱ U.S. Immigrant/Permanent
Resident ٱ F-1
Student ٱ J-2
Spouse or Child of Exchange
ٱ Visitor ٱ J-1
Exchange Visitor ٱ H-1
Temporary Employee
ٱ Other: _____________________________________________________________________________________________
If Immigration Status is J-1, what
is the category? Check one:
ٱ 01 Student ٱ 05
Professor ٱ 12
Research Scholar
ٱ 02 Short Term Scholar ٱ Other: ___________________________________________________
What is the actual primary
activity of the visit? Check one:
ٱ 01 Studying in a Degree
Program ٱ 02
Studying in a Non-Degree Program
ٱ 05 Observing ٱ 07
Conducting Research
ٱ 11 Temporary Employee ٱ 12
Here with Spouse
What is the actual date you
entered the United States (stamped on I-94)? _____ /_____ /_____
month day
year
What is the start date of your
immigration status? _____ /_____ /_____
month day
year
When does your I-20 expire? _____
/_____ /_____
month day
year
What type student?
ٱ Undergraduate ٱ Masters ٱ Doctoral ٱ Other: ___________________________
Spouse in USA?
ٱ Yes ٱ No Number
of dependents: ____________________
For consultants/self employed
individuals:
Do you/will you have an office
(fixed base) in the USA?
ٱ Yes ٱ No If
yes, how many days in this tax year did you/will you have office (fixed
base)? ___________________
Country of residence if different
from foreign residence address: _____________________________________________
Did tax residency end?
ٱ Yes ٱ No If
yes, when? _____ /_____ /_____
month day
year
The Foreign National Information
Form must be completed before you can receive any form of payment. Please list any VISA immigration activity in
the 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?
___ /___
/___ ___ /___ /___ ___________________ __________ ____________
ٱ Yes ٱ No
___ /___
/___ ___ /___ /___ ___________________ __________ ____________
ٱ Yes ٱ No
___ /___
/___ ___ /___ /___ ___________________ __________ ____________
ٱ Yes ٱ No
___ /___
/___ ___ /___ /___ ___________________ __________ ____________
ٱ Yes ٱ No
___ /___
/___ ___ /___ /___ ___________________ __________ ____________
ٱ Yes ٱ No
VISA
Immigration Status:
ٱ U.S. Immigrant/Permanent
Resident ٱ F-1
Student ٱ J-2
Spouse or Child of Exchange
ٱ Visitor ٱ J-1
Exchange Visitor ٱ H-1
Temporary Employee
ٱ Other: _____________________________________________________________________________________________
Primary
Purpose:
ٱ 01
Studying in a Degree Program ٱ 02
Studying in a Non-Degree Program
ٱ 05
Observing ٱ 07
Conducting Research
ٱ 11
Temporary Employee ٱ 12
Here with Spouse
I hereby certify that all of the above information is true and correct. I understand that if my status changes from that which I have indicated on this form I am responsible for submitting a new Foreign National Information Form to the Payroll Department.
Signature: ________________________________________________________ Date: _____________________________
Local Phone #: _________________________ Fax #: _________________________ Work: _________________________
E-mail address: ___________________________________________________________
How to complete the Foreign National Information Form:
01) Name: List
full name.
02) Social Security #:
Enter US social security number issued by the US Social Security
Administration not your ID number. Do
not list
numbers
not assigned the United States Social Security, i.e. Canada social security
number. All employees must have a
social
security
number in order to work. In none, enter
your ITIN issued by the IRS.
03) ID#: Enter
your Employee/Student/Faculty identification number.
04) Local Street Address: List
your local US address.
05) Residence: List your
non-US address.
06) Country of Citizenship
07) Country that Issued Passport: List the country in which you were issued your passport, not the
country where is was issued.
08) Passport #: Enter your
passport # and expiration date.
09) 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
Resident,
holder of a “green” card, you may proceed to the bottom of this form; sign and
date.
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) Is your spouse in the USA? Give number of other dependents in the USA.
19) Consultants/Self-employed Individuals: Check the appropriate box.
This includes any office at any location specifically identified
with
you.
20) Tax residence is where you last paid taxes as a resident and can
be different from legal residence. Do
not include the USA.