Fillable Foreign National Tax Information (Saint Louis University)

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Foreign National Tax Information (Saint Louis University)

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The Foreign National Tax Information (Saint Louis University) form is 2 pages long and contains:

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  • 38 check-boxes
  • 86 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Saint Louis University

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1. Last or Family Name: First: Middle:
2. Social Security #: 3. Banner #: 4.Date of Birth: MM/DD/YY
Address Line 2
Address Line 3/City
Postal Code
Providence/Region
Country
7. Country of Citizenship:
8. Country that issued Passport:
9. Passport #: 10. Visa #: (not the control number, see directions)
11. Your Current U.S. Immigration Status:
U.S. Immigrant/Permanent Resident J-1 Exchange Visitor
F-1 Student J-2 Spouse or Child of Exchange Visitor
H-1 Temporary Employee Other
12. If Immigration Status is J-1, What is the Category? (Check Only One)
01 Student 04 Physician
02 Short-Term Scholar 05 Research Scholar
03 Professor Other
13. What is the Primary Purpose of your Current Stay in the U.S.? (Check Only One)
01 Studying in a Degree Program 07 Conducting Research
02 Studying in a Non-Degree Program 08 Training
03 Teaching 09 Demonstrating Special Skills
04 Lecturing 10 Clinical Activities
05 Observing 11 Temporary Employment
06 Consulting 12 Here with Spouse
14. What is the Actual Date you 15. What is the Start Date on 16. What is the Projected
present immigration status?
your current immigration form?
(i.e., DS-2019, I-20, or I-797)
Telephone Number
City
State/Zip Code
5. US Local Street
Address
6.Foreign Residence
Address
first entered the U.S. in your
Foreign National Tax Information Form
The Foreign National Tax Information Form must
be completed before you can receive any form of payment.
All applicable questions below must be answered. Legible copies of your Passport, your U.S. Visa and Visa
Stamp Page(s), your I-94 Form "Arrival and Departure Record" and (if applicable) your I-20, DS-2019 or I-797
must be attached to this form. This form must be returned before any check can be issued by the Payroll
Services Department.
End Date of your present
immigration status?
Address Line 2
Address Line 3
17. If a Student, What Type? 18. Married? Spouse in USA?
Undergraduate Graduate Yes No Yes No
Post Graduate Medical Student
Recipient of a Scholarship/Fellowship from SLU? Number of dependents:
Yes No
19. For Independent Contractors/Self-Employed Individuals: 20. Country of Tax Residence if Different
from Residence Address:
Yes No
If Yes, how many days in this tax year did you/will you Did tax residency end? Yes No
have Office (fixed base)? Days If yes, when?
Prior U.S. Immigration Activity
21. Please list all periods of stay in the U.S. during the last 3 calendar years and all F, J, M, or Q Visa
periods since Jan. 1, 1985. (Please attach a separate sheet, if necessary)
Entry to
US
Exit from
US
Visa
Immigration
Status
J-1
Subtype
DIRECTIONS: Please print all information neatly.
1. Name: Print full name
3. Banner #: Enter your Banner Identification Number if applicable.
4. U.S. Local Street Address. List your local home address.
5. Foreign Residence Address. List your permanent address abroad.
11. Sign and date form below.
If your country has a tax treaty with the U.S., but you elect not to use these benefits, please
initial here.
Signature _____________________________________ Date ________________________________
8. Current U.S. Immigration Status. Check the type of immigration status that you currently hold. If you
check U.S. Immigrant/Permanent Resident, proceed to the bottom of the form. Sign & date.
9. Independent Contractors/Self-Employed Individuals. Check the appropriate box. This includes any office at
any location specifically identified with you.
10. Tax Residency. Tax residence is where you last paid taxes as a resident, and can be different from legal
residence. Do not include the U.S. unless you have met the Substantial Presence Test.
2. Social Security Number: Enter US social security number issued by the US Social Security Administration. Do
not list numbers not assigned by U.S. Social Security Admin., i.e. Canadian social security number. All
employees must have a social security number in order to work.
6. Visa Number. List your U.S. Visa Number (not the control number). It is usually an eight-digit number found
below the expiration date.
7. Actual Date of Entry, Start Date, and Projected End Date. Must include month, day, and year for all.
Approximate if you are unsure.
I hereby certify that all of the above information is COMPLETE, TRUE, and CORRECT. I understand
that if my status changes from that which I indicated on this form, I must submit a new Foreign
National Tax Information Form.
Do you/will you have an office (fixed base) in the U.S.?
Purpose of Stay
Have you Taken
Treaty Benefits?
(Yes or No)
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Foreign National Tax Information (Saint Louis University)

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Completed 20 July 2020

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