FOREIGN NATIONAL INFORMATION FORM
All foreign nationals who receive compensation and/or scholarship/fellowship from Columbia University
must complete this form. The information provided will be used to determine your status (Non Resident
or Resident Alien) under US tax regulations.
Last or Family Name:
Are you a Permanent Resident?
U.S. Local Address:
First Name:
Yes:
No:
Middle:
If yes, proceed to section 12.
Foreign Residence Address:
Address Line 1:
Address Line2:
Address Line 3/City:
Postal Code:
City:
State:
Zip Code:
Province/Region:
Foreign Country:
Country of Citizenship:
Passport#:
Country that Issued Passport:
Expiration Date:
MM/DD/YYYY
Country of Tax Residence, if different from Foreign Residence Address:
Current Immigration:
Immigration Status:
F-1 Student
F-2 Spouse of Student (F-1)
J-1 Exchange Visitor
J-2 Spouse of Exchange Visitor (J-1)
H-1 Temporary Employee
O-1 Alien with Extraordinary Abilities
O-2 Personnel Accompanying O-1 Alien
If Immigration Status is J-1, what is the Subtype?
(Located on section #4 in form DS2019)
Student
Professor
Research Scholar
Short term Scholar
Other:
Other:
What is the actual date you entered the U.S.A. on your current visa?
MM/DD/YYYY
/
/
(Month/Day/Year)
What is the projected end date of your immigration status for this activity?
MM/DD/YYYY
/
/
(Month/Day/Year)
(Please use date from Form I-20 or DS2019)
FOREIGN NATIONAL INFORMATION FORM (Part Two)
Have you ever had previous immigration status in the United States?
Yes:
No:
(If yes, see below)
Please list any U.S. Visa Immigration activity in the last three calendar years and all F, J, M or Q Visas since 01/01/1985:
Date of Entry
Date of Exit
MM/DD/YYYY
MM/DD/YYYY
MM/DD/YYYY
Visa
Immigration
Status
If J-1,
Subtype
Primary
Activity
Have you taken any Treaty
Benefits?
Yes
No
MM/DD/YYYY
Yes
No
MM/DD/YYYY
MM/DD/YYYY
Yes
No
MM/DD/YYYY
MM/DD/YYYY
Yes
No
MM/DD/YYYY
MM/DD/YYYY
Yes
No
MM/DD/YYYY
MM/DD/YYYY
Yes
No
MM/DD/YYYY
MM/DD/YYYY
Yes
No
MM/DD/YYYY
MM/DD/YYYY
Yes
No
Note: Time away due to vacation do not need to be recorded on the chart above
I hereby certify that all of the above information is true and correct. I understand that if my status
changes from what I have indicated on this form, I must submit a new Foreign National Information
Form.
Signature:
Date:
MM/DD/YYYY
Please return completed form to:
Human Resources Processing Center
Attn: Johnny Martinez
615 West 131st Street
Studebaker Building, Floor 4th, MC 8702
New York, NY 10027
For Further information please call:
Carlos Lira-Coppo (212)851-2849
Johnny Martinez (212)851-2816
CU Internal Mail Service
J Martinez
Studebaker Building, 4Th Floor
MC 8702