Revised March 6, 2017
UWG H-1B Acknowledgement Form
Date of Request:
Employee Name:
Position:
Supervisor:
Department:
Employment Date:
Employment Authorization Start Date (if different
from Employment Date):
Justification (Include justification if an H-1B is being requested for a non-tenure track faculty member):
H-1B work visas are valid for an initial three year period, at which time the petition may be extended for
another three year period, at additional costs incurred by the department, for a total period of six
years. After the six years is exhausted, employment must be terminated, unless the employee becomes
a permanent resident during that time. Permanent residency may be pursued independently, or through
University support for qualified positions.
By signing this agreement, the parties below are attesting that they understand the temporary nature of
an H-1B work visa:
_______________________________________________ _____________________
Department Approver Date
_______________________________________________ _____________________
Dean Date
_______________________________________________ _____________________
Human Resources Date
_______________________________________________ _____________________
Vice President Date
HR Use Only:
Estimated Cost (regular vs.
premium):
Country of Origin:
Current Status:
Other