ISO:Forms/FNIF Page 1 8/12/2009
FLORIDA GULF COAST UNIVERSITY
FOREIGN NATIONAL INFORMATION FORM (FNIF)
Please check one of the following:
Initial Submission required prior
Update – required only if any information in Section B, C or D
to first payment
changes during individuals stay in the U.S.
Please attach a copy of the following to this form:
U.S. Social Security card U.S. Visa I-94 Departure Record I-20, DS-2019 or I-797 Passport
(Please use MONTH/DATE/YEAR format when completing this form.)
1. Last Name/Surname Middle Initial First Name/Given Name
2. U.S. Social Security Number 3. Date of Birth
or U.S. Individual Taxpayer Identification Number
4. U.S. Local Street Address 5. Foreign Residence Address
6. Local Telephone Number 7. Email Address
7. If married, is your spouse in the U.S.? Yes No 9. Number of dependents in U.S. (excluding spouse)
10. Visa Number 11. Issue Date
12. Visa Type - select one
B-1 WB (Waiver for Business) J-1 Research Scholar H-1B J-1 Student
B-2 WT Waiver for Tourism J-1 Short Term Scholar TN F-1 Student
Canadian Walk Over J-1 Professor O-1
Other - please specify: J-1 Alien Physician
13. Primary Purpose/Activity of Visit select one
Studying for degree program Consulting Conducting Research
Studying in a a non-degree program Teaching Acquiring Training
Lecturing Clinical Activities Temporary Employment
Other – please specify:
14. County of Citizenship 15. Passport Number
16. Passport Expiration Date 17. Country Issuing Passport
FLORIDA GULF COAST UNIVERSITY
International Services
10501 FGCU Blvd S - Reed Hall 122
Fort Myers FL 33965-6565 (239) 590.7925
FOR ASSISTANCE CONTACT
Section A - General Information
Section B Visa and Passport Information
UIN:
ISO:Forms/FNIF Page 1 8/12/2009
18. What is the actual date you entered the U.S. on your current visa?
19. What is the start date and end date of your primary purpose/activity indicated on your current I-20,DS-2019, I-797?
Start Date: End Date:
20. U.S. Visa Immigration History:
List all visits to the U.S. in the last 3 calendar years.
List all F, J, M or Q visa periods since January 1, 1988.
(Students do not need to list short vacations home during semester breaks.)
Have you taken any
Date of U.S. Entry Date of U.S. Exit Visa Type Primary Purpose of Stay treaty benefits?
YES NO
YES NO
YES NO
YES NO
YES NO
21. Prior to your current visit to the U.S., in what country were you employed and paying taxes?
22. Please check the appropriate box.
If you are unsure, leave blank and the NRA Tax Coordinator will determine your status.
I am a U.S. Permanent Resident. Alien Registration Receipt Card (Green Card) Number.
I am or have been classified previously as a Resident Alien for tax purposes.
I am a Non-Resident Alien for tax purposes. I do not meet the requirements for tax residence in the U.S.
Is the activity to receive the Honorarium to last more than 9 days? YES NO
Did you receive an Honorarium from more than 5 organizations in the prior 6 months? YES NO
Is the activity to be performed a normal academic activity? YES NO
If you country has a tax treaty with the U.S. but you elect NOT to use these benefits, please initial here:
I certify that all of the above information is true and correct. I understand that if my Passport and Visa information changes, I must
submit a new Foreign National Information Form (FNIF) reflecting these changes to FGCU International Services.
___________________________________________________________ ________________________
Signature Date
Section D Residence Status for Tax Purposes
Section C Visa Immigration Activity
Section E To be Completed by Individuals Receiving Honorarium Payments
CERTIFICATION
Employee UIN______________________________ FICA Status ________________ Job Code ______________
Annual Salary ____________________ Working Department ________________________________
FOR OFFICIAL USE ONLY
click to sign
signature
click to edit
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