Fillable All applicable questions below must be answered. Please (Metropolitan State College of Denver)

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All applicable questions below must be answered. Please (Metropolitan State College of Denver)

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FOREIGN
NATIONAL
INFORMATION
FORM
All applicable questions below must be answered. Please include a copy of both sides of your I-94 Form “Arrival and Departure Record”, (a small white
card inside your passport), copy of your U.S. VISA, and I-20 or DS-2019, if applicable.
(1) Last or Family Name: First: Middle:
(2)
Social
Security
#:
(3) ID #
:
(4) U.S. LOCAL
STREET
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:
(8) Passport #:
(7) Country That Issued Passport:
(9) Visa #:
(10) Have you ever had another immigration status in the United States? ( )Yes. ( ) No. If yes, see page 2.
(11) IMMIGRATION STATUS:
U.S. Immigrant/Permanent Resident F-1 Student J-2 Spouse or Child of Exchange Visitor
J-1 Exchange Visitor H-1 Temporary Employee
Other:
(12) IF IMMIGRATION STATUS IS J-1, WHAT IS THE SUBTYPE? CHECK ONE:
01 Student 05 Professor 12 Research Scholar
02
Short
Term
Scholar
Other:
(13) WHAT IS THE ACTUAL PRIMARY ACTIVITY OF THE VISIT? CHECK ONE:
01 Studying in a Degree Program
05 Observing
09 Demonstrating Special Skills
02 Studying in a Non-Degree Program
06 Consulting
10 Clinical Activities
03 Teaching
07 Conducting Research
11 Temporary Employment
04 Lecturing
08 Training
12 Here with Spouse
(14) WHAT IS THE ACTUAL DATE YOU
ENTERED THE UNITED STATES?:
(15) WHAT IS THE START DATE OF YOUR
IMMIGRATION STATUS FOR THIS
PRIMARY ACTIVITY?:
(16) WHAT IS THE PROJECTED END DATE
OF YOUR IMMIGRATION STATUS
PRIMARY ACTIVITY?:
/_ _/ /_ _/ /_ _/
Month Day Year
Month Day Year
Month Day Year
(17) INCOME PROVIDING ACTIVITY
(e.g. JOB TITLE):
(18) WHAT TYPE OF STUDENT?:
Undergraduate Masters
Doctoral
Other
(19) SPOUSE IN USA?:
Yes No
Number
of
dependents
(20) FOR CONSULTANTS/SELF EMPLOYED INDIVIDUALS:
Do you / will you have an office (fixed base) in the USA?
Yes No If yes, how may days in this tax year did you / will you
have office (fixed base)?
Days
(21) COUNTRY OF TAX RESIDENCE IF DIFFERENT FROM FOREIGN
RESIDENCE ADDRESS:
Did tax residency end? Yes No If yes, when / /_
Month Day Year
I hereby certify that all of the above information is true and correct. I understand that if my status changes from which I have indicated on this form I must
submit a new Foreign National Information Form to the Payroll Department.
Signature
Local
Phone
Number:
Date:
MSU Denver-International Employees Only
click to sign
signature
click to edit
FOREIGN
NATIONAL
INFORMATION
FORM
PLEASE LIST ANY VISA IMMIGRATION ACTIVITY IN LAST THREE CALENDAR YEARS AND ALL F, J, M OR Q VISIAS.
Date of Entry
Date of Exit
J-1 Subtype
Primary Activity
Have You Taken
Any
Treaty
Benefits
/
_/
/
_/
Yes No
/
_/
/
_/
Yes No
/
_/
/
_/
Yes No
/
_/
/
_/
Yes No
/
_/
/
_/
Yes No
/
_/
/
_/
Yes No
/
_/
/
_/
Yes No
/
_/
/
_/
Yes No
VISA IMMIGRATION
STATUS:
U.S. Immigrant/Permanent Resident F-1 Student J-2 Spouse or Child of Exchange Visitor
J-1 Exchange Visitor H-1 Temporary Employee
Other:
J-1
SUBTYPE:
01 Student 05 Professor 12 Research Scholar
02
Short
Term
Scholar
Other:
PRIMARY
ACTIVITY:
01 Studying in a Degree Program 05 Observing 09 Demonstrating Special Skills
02 Studying in a Non-Degree Program 06 Consulting 10 Clinical Activities
03 Teaching 07 Conducting Research 11 Temporary Employment
04 Lecturing 08 Training 12 Here with Spouse
99
Other,
please
specify:
I hereby certify that all of the above information is true and correct. I understand that if my status changes from which I have indicated on this form I must
submit a new Foreign National Information Form to the Payroll Department.
Signature Local Phone
Number:
Date:
HOW TO COMPLETE THE FOREIGH NATIONAL INFORMAITON FORM:
1. Name: List full name. currently hold. If you check U.S. Immigrant / Permanent Resident,
2. Social Security Number: Enter US social security number issued by holder of a “green” card, you may proceed to the bottom of the form.
the US Social Security Administration not your ID number. Do not Sign and date.
list numbers not assigned by the United States Social Security, i.e 12. Immigration Status for J-1: Check the appropriate J-1 subtype.
Canadian social security number. All employees must have a social 13. Actual Primary Activity: Check one activity.
security number to work. If none, enter your ITIN issued by 14. Actual Entry Date into the United States: Must include month, day
the IRS. and year. Approximate if you don’t know.
3. ID#: Enter your
Employee/Student/Faculty
Identification Number. 15. Start Date: Must include month, day and year. Approximate if you
4. Local Street Address: List your local US address. don’t know.
5. Residence: List your non-US address. 16. End Date: Must include month, day and year. Approximate if you
6. Country of Citizenship(s). don’t know.
7. Country that Issued Passport: List country in which you were issued 17. Occupation: Describe in general the service you will perform.
your passport. Not the country where it was issued. 18. Check the appropriate box.
8. Passport #: Enter your passport number. 19. Is your spouse in the USA? Check the appropriate box. Give number
9. Visa #: Enter your Visa number. of other dependents in the USA.
10. Immigration Status: Check yes or no. If yes, complete the above form 20. Consultants / Self-employed Individuals: Check the appropriate box.
for the time you were present in the United States. Approximate if you This includes any office at any location specifically identified with you.
don’t know. 21. Tax residence is where you last paid taxes as a resident and can be
11. Immigration Status: Check the type of immigration status that you different from legal residence. Do not include the USA.
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Completed 18 September 2020

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