UNIVERSITY OF WISCONSIN – WHITEWATER
STAFF IMMIGRATION FORM
SURNAME (FAMILY NAME): ______
(Please write EXACTLY as it appears in your passport)
GIVEN NAME (S): ______
CURRENT STREET ADDRESS: ______
CITY AND STATE: ______
ZIP CODE/POSTAL CODE: ______
TELEPHONE NUMBER: ______
E-MAIL ADDRESS: ______
GENDER: ______M ______F
MARITAL STATUS: ____Married _____Engaged _____Separated _____Not Married
BIRTHDATE: (mm/dd/yyyy) _____/_____/______
CITY, PROVINCE AND COUNTRY OF BIRTH: ______
COUNTRY OF PERMANENT LEGAL RESIDENCE: ______
COUNTRY OF CITIZENSHIP: ______
COUNTRY ISSUING PASSPORT: ______
PASSPORT #: ______EXP. DATE: ______
U.S. SOCIAL SECURITY # (if applicable): ______
PREVIOUS VISA TYPES HELD: ______
ARE YOU CURRENTLY OUTSIDE OF THE U.S. OR PLANNING TO TRAVEL OUTSIDE THE U.S. BEFORE YOU OBTAIN YOUR VISA? ______YES ______NO
IF YES, PLEASE LIST THE CITY AND COUNTRY OF THE U.S. CONSULATE/EMBASSY WHERE YOU WILL APPLY FOR YOUR VISA ______
IF NO, ANSWER THE FOLLOWING:
_____ I AM REQUESTING A TRANSFER OR EXTENSION OF MY CURRENT VISA CLASS, OR
_____ I AM REQUESTING A CHANGE OF VISA CLASS FROM ______TO ______.
TRAVEL TO THE U.S.:
NOTE: Your visa documents will be sent to you from the UW-Whitewater Office of Human Resources & Diversity as soon as possible, however, please note that processing times will vary. You are advised to confirm your travel arrangements to the U.S. only after obtaining your visa documents from UW-Whitewater and from the U.S. consulate. If you confirm your plans prior to the receipt of your documents, you do so at your own risk. We cannot guarantee that you will receive your documents or obtain your visa stamp prior to your departure date.
PLEASE LIST THE NAMES OF ANY DEPENDENTS THAT WILL ALSO REQUIRE VISAS:
Last Name First Name Gender Relationship Date of Birth (mm/dd/yyyy)
______
______
______
______
REQUIRED DOCUMENTATION:
Please also submit photocopies of the following documents along with this form:
______I-94 CARD (front and back)
______CURRENT PASSPORT
______CURRENT VISA
______WORK AUTHORIZATION DOCUMENTS
______IF CURRENTLY IN THE U.S., PREVIOUS IMMIGRATION DOCUMENTS (I-20, DS-2019, PREVIOUS H-1B APPROVAL NOTICES, ETC.)
______DIPLOMAS/DEGREES (INCLUDE TRANSCRIPT OR DIPLOMA (TRANSLATION IF NOT IN ENGLISH) FOR HIGHEST DEGREE, CREDENTIAL EVALUATION IF DEGREE IS NOT FROM A U.S. UNIVERSITY.)
______ANY PUBLISHED MATERIAL IN PROFESSIONAL PUBLICATIONS
PLEASE RETURN THIS COMPLETED FORM, ALONG WITH ANY REQUESTED DOCUMENTS TO:
E-mail:
OR
Fax: 262-472-1491
OR
Mail to: Center for Global Education
ATTN: Erika Cuevas
University of Wisconsin-Whitewater
800 W. Main Street
Whitewater, WI 53190 USA
staffimmigrationintake.doc – 3/2011