Payroll Office, Building 20E, Room 103 Revised 10/03/2018
The University of West Florida
________________________
Department
Certification of Academic Activity
The American Competitiveness Workforce Act of 1998 allows payment of honoraria and
associated incidental expenses to B-1, B-2, WB, and WT visa holders for “usual academic
activity,” if paid by a United States institution of higher education, a nonprofit organization
affiliated with an institution of higher education, or a nonprofit or a governmental research
organization. Under the Act, an academic activity may not exceed nine days at a single
institution. In addition, such visa holders cannot accept honoraria and/or incidental expenses
from more than five such institutions or organizations in the previous six month period.
Visitor Information
Last Name: ____________________________ First Name: ___________________________
The dates of my activity at the University of West Florida will be from _________ to ________
Please note: Academic activity at the University of West Florida cannot exceed nine days.
Acknowledgement
I have accepted an invitation by the University of West Florida for the purpose of engaging in
an academic activity. I will receive an honorarium payment and/or reimbursement for
incidental expenses for my academic activity.
I have not accepted honoraria and/or incidental expense reimbursements within the prior six
month period from more than four institutions of higher education, a nonprofit organization
affiliated with an institution of higher education, or a nonprofit or a governmental research
organization.
Please note: The University of West Florida cannot make an honorarium and/or incidental
expense payment to you if you have received such payments from more than four of these
organizations within the past six months.
Certification
I certify that the information contained on this form is to the best of my knowledge and belief,
true and complete.
Signature of Nonresident Alien: ________________________________ Date: ___________
