NOTE: This is the same information asked for on your tax forms. Fill out this sheet and bring it to the tax workshop. You will copy the information onto the online tax forms. Having this information available beforehand will save you time!
· Passport Number: ______
· Current visa/immigration status. Select One F-1 ___ J-1 ___ F-2___ J-2 ___ Other ______
· Your original date of entry to the U.S. for the purpose of this visit: mm/dd/yy______
· The end date of this visit (enter your graduation date; it’s on I-20): mm/dd/yy______
· Have you changed your immigration status since arriving in the U.S. for this visit?
Different______Same ______
· Is this the first time you have been to the U.S.?
Yes______No ______
· How long have you been present in the United States
Calendar Immigration Status Estimated total Days Days not present
Year Present calendar year
2011 ______from the day you arrived as F-1 ______
2010 ______365 ______
2009 ______365 ______
2008 ______365 ______
2007 ______365 ______
Country of Citizenship: (If you are a citizen of 2 countries, please select the country under whose documents you entered the U.S. If you are a dual citizen of the U.S. and another country, for U.S. tax purposes you are treated as a citizen of the U.S.)
Passport Country: Country under whose passport you entered U.S.______
Country of Tax Residence: Typically this is the same as your country of permanent residence.
What income forms/statements did you receive? Please check all that apply.
___ Form W-2 ___ Form 1042S ___ Form 1099-MISC (miscellaneous income)
___Form 1099 INT (Interest) ___ Form 1099-DIV (Dividends) ____ Form 1099-B (Broker/Barter)
___Form 1099-G (State Tax Refund) ____ Form 1099-R
· What is your marital status? If you were not married at anytime during 2011, mark “Single”.
NOTE: If you are married and your spouse resides in another country, you ARE still considered married.
______Single ______Married
· During the tax year 2011 did you make any charitable donations to US organizations (religious, charitable, educational, scientific, or literary? ______yes ______no
NOTE: If you answer “YES” to this you will be required to file form 1040 NR (Long Form)
· Personal information
What is your social security number of Taxpayer Identification number (ITIN)
Do not include dashes when typing in SS number ______
What is your current U.S. Mailing address?
Street address ______
City ______State ______Postal Code ______
What is your permanent foreign mailing address:
Street address ______
City ______State/Province _____ Postal Code ______Country ______
Name of Academic Advisor: WRITE THE FOLLOWING: Donna Van Handle
Phone number of Advisor: WRITE THE FOLLOWING: 413-538-2072
· What is your relationship to the U.S.?
Have you ever been a U.S. citizen Yes ______No ______
Have you ever been a U.S. permanent resident alien (i.e., “greencard holder”)?
Yes ______No ______
Did you surrender your U.S. permanent resident status during 2011?
Yes______No ______
During the tax year 2011 did you apply for or take other affirmative steps to apply for lawful permanent resident status in the U.S. or have an application pending to change your status to that of a lawful permanent resident of the U.S.?
Yes ______No ______
Please explain what action you have taken
Please indicate the departure and entry dates for each of your MOST recent temporary leaves from the U.S. during the tax year 2011.
Departure Date #1 Day ______Month ______Year ______
Reentry date #1 Day ______Month ______Year ______
Departure Date #2 Day ______Month ______Year ______
Reentry date #2 Day ______Month ______Year ______
Departure Date #3 Day ______Month ______Year ______
Reentry date #3 Day ______Month ______Year ______
· Have you ever filed a U.S. income tax return?
Yes ______No ______
What was the most recent year you filed an income tax return? ______
Which income tax return did you file? ____(probably 1040NR-EZ)____
· Finishing your tax return
Would you like to receive a tax refund check or have the tax refund directly deposited to your account in a U.S. bank or financial institution?
Direct deposit ______Check______
Please enter the U.S. bank routing number (ABA number) which is nine (9) digits.
______
Please enter the U.S. bank account number which is up to seventeen (17) digits.
THIS IS NOT THE NUMBER ON YOUR DEBIT CARD—it is on your checks!
______
Bank Routing Number for Bank of America in Massachusetts: 011000138
Bank Routing Number for PeoplesBank: 211871772
Please select the type of U.S. bank account
Checking______Savings______