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Foreign-national-info Word - FOREIGN NATIONAL INFORMATION FORM.do

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FOREIGN
NATIONAL
INFORMATION
FORM (PAGE
1
)
The Foreign National Information Form must be completed before you can receive any form of p
a
y
ment.
All applicable questions below must be answered. A copy your I-94 Form, your U.S. VISA from your passport, and a copy of your I-20 or DS-2019 must be
attached to this form. If you have any questions, please call Kristie Peppers at 850-474-3169.
(1) Last or Family Name: First: Middle:
(2)
UWF ID
#:
_____________________________________________
(3) U.S. LOCAL
STREET
ADDRESS: (4) FOREIGN RESIDENCE ADDRESS:
Address Line 2:
Address Line 2:
Address Line 3:
City:
City:
Postal Code:
Province/Region:
State:
Zip:
Foreign Country:
(5) Country of Citizenship:
(7) Passport #:
(6) Country That Issued Passport:
(8) Visa #:
(9) Have you ever had another immigration status in the United States? ( )Yes. ( ) No. If yes, see page 2.
(10) 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:
(11) IF IMMIGRATION STATUS IS J-1, WHAT IS THE SUBTYPE? CHECK ONE:
01 Student 05 Professor 12 Research Scholar
02
Short
Term
Scholar
Other:
(12) 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
(13) WHAT IS THE ORIGINAL DATE YOU
ENTERED THE UNITED STATES?
(14) WHAT IS THE START DATE OF YOUR
IMMIGRATION STATUS FOR THIS
PRIMARY ACTIVITY?
(15) WHAT IS THE PROJECTED END DATE
OF YOUR IMMIGRATION STATUS
PRIMARY ACTIVITY?
/ / / / / /
Month Day Year
Month Day Year
Month Day Year
(16) OCCUPATION:
(e.g. PROFESSOR OF CHEMISTRY)
(17) TYPE OF STUDENT:
Undergraduate Masters
Doctoral
Other
(18) SPOUSE IN USA:
Yes No
Number
of
dependents
(19) 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
(20) COUNTRY OF TAX RESIDENCE IF DIFFERENT FROM FOREIGN
RESIDENCE ADDRESS:
Did tax residency end? Yes No If yes, when / /
Month Day Year
___________________________________
FOREIGN
NATIONAL
INFORMATION
FORM (PAGE 2)
PLEASE LIST ANY VISA IMMIGRATION ACTIVITY IN LAST SIX CALENDAR YEARS
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:
Phone
Number:
Date:
INSTRUCTIONS:
11. Immigration Status for J-1: Check the appropriate J-1 subtype.
12. Actual Primary Activity: Check one activity.
13. Actual Entry Date into United States: Must include month, day
and year.
14. Start Date: Must include month, day and year.
15. End Date: Must include month, day and year.
16. Occupation: List the service you will perform.
17. Check the appropriate box
18. Is your spouse in the USA? How many dependents in USA?
19. Consultants/Self-employed: Check appropriate box.
20. Tax residence is where you last paid taxes as a resident. May
be different from legal residence. Do not include the USA.
1. Name: List full name.
2. UWF ID#: Enter your
Employee/Student/Faculty
Identification Number.
3. Local Address: List your local US address.
4. Foreign Residence Address: List your non-US address.
5. Country of Citizenship(s)
6. Country that Issued Passport: List the country in which you were issued
your passport.
7. Passport #: Enter your passport number.
8. Visa #: Enter your VISA number (an 8-digit number in RED on
Visa in your passport)
9. Immigration Status: Check yes or no. If yes, complete the above form for
the time you were present in the United States.
10. Immigration Status: Check the type of immigration status that you currently
hold. If you checked US Immigrant/Permanent Resident, you may proceed
to the bottom of this form and sign.
Date of Entry Date of Exit Visa Immigration Status J-1 Subtype Primary Purpose
____ ____ ____ ____ ____ ____ ________________ _______________ ______________________
____ ____ ____ ____ ____ ____ ________________ _______________ ______________________
____ ____ ____ ____ ____ ____ ________________ _______________ ______________________
____ ____ ____ ____ ____ ____ ________________ _______________ ______________________
____ ____ ____ ____ ____ ____ ________________ _______________ ______________________
____ ____ ____ ____ ____ ____ ________________ _______________ ______________________
____ ____ ____ ____ ____ ____ ________________ _______________ ______________________
____ ____ ____ ____ ____ ____ ________________ _______________ ______________________
____ ____ ____ ____ ____ ____ ________________ _______________ ______________________
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Completed 25 February 2020

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