FOREIGN NATIONAL INFORMATION FORM
This Form must be completed before you can receive any form of payment from the University of Hawaii Foundation
All applicable questions below must be answered. A copy of both sides of your I-94 Form “Arrival and Departure Record” (a small white card inside your passport), copy of your U.S. Visa from your passport, and Form I-20 “Certificate of Eligibility for Nonimmigrant (F-1) Student Status—for Academic and Language Students” or Form IAP-66 (DS-2019) “Certificate of Eligibiilty for Exchange Visitor (J-1) Status” must be attached to this form. This form must be returned before any check can be issued by the University of Hawaii Foundation (UHF) and must also be completed by anyone receiving a scholarship/fellowship, grant or award.
(1)Name: Last or Family Name: First:Middle:
(2)Social Security #:
(3)U.S. Local Street Address:(4) Permanent Foreign Address:
Address Line 2:Address Line 2:
Address Line 3:Address Line 3/City:
City:Postal Code:Province/Region:
State:Zip:Foreign Country:
(5)Country of Citizenship:(6)Country That Issued Passport:
(7)Passport #:(8)Visa #:
(not the control number that begins with a year)
(9)Have you ever had another immigration status in the United States?O YesO No
(10)Immigration Status:
O U. S. Immigrant/Permanent ResidentO F-1 StudentO J-2 Spouse or Child of Exchange Visitor
O J-1 Exchange VisitorO H-1 Temporary EmployeeO Other:
(11)If immigration status is J-1, what is the subtype? Check one:
O 01 StudentO 05 ProfessorO 12 Research Scholar
O 02 Short Term ScholarO Other:
(12)What is the actual primary activity of the visit check one:
O 01 Studying in a Degree ProgramO 05 ObservingO 09 Demonstrating Special Skills
O 02 Studying in a Non-Degree ProgramO 06 ConsultingO 10 Clinical Activities
O 03 TeachingO 07 Conducting ResearchO 11 Temporary Employment
O 04 LecturingO 08 TrainingO 12 Here with Spouse
(13) What is the actual date you entered the United States?: / (14) What is the start date of your immigration status for this primary activity?: / (15) What is the projected end date of your immigration status primary activity?:______/____/_____
Month Day Year / ______/____/_____
Month Day Year / ______/____/_____
Month Day Year
(16) What type student:
O UndergraduateO Masters
O DoctoralO Other: / (17) Country of tax residence if different from foreign residence address:
Did tax residency end? O YesO NoIf yes, when? ______/____/_____
Month Day Year
I hereby certify that all of the above information is true and correct. I understand that if my status changes from that which I have indicated on this form I must submit a new Foreign National Information Form to the UHF Fiscal Office.
Signature:Local Phone Number:E-mail: Date:
FOREIGN NATIONAL INFORMATION FORM (page 2)
This Form must be completed before you can receive any form of payment from the University of Hawaii Foundation
PLEASE LIST ALL F, J, M OR Q VISAS SINCE JANUARY 1, 1985 AND ANY OTHER VISA IMMIGRATION ACTIVITY IN LAST THREE CALENDAR YEARS :
Date of Entry / Date of Exit / Visa Immigration Status / J-1 Subtype / Primary Activity / Have You Taken Any Treaty Benefits?______/____/_____ / ______/____/_____ / ______/ ______/ ______/ O Yes / O No
______/____/_____ / ______/____/_____ / ______/ ______/ ______/ O Yes / O No
______/____/_____ / ______/____/_____ / ______/ ______/ ______/ O Yes / O No
______/____/_____ / ______/____/_____ / ______/ ______/ ______/ O Yes / O No
______/____/_____ / ______/____/_____ / ______/ ______/ ______/ O Yes / O No
______/____/_____ / ______/____/_____ / ______/ ______/ ______/ O Yes / O No
______/____/_____ / ______/____/_____ / ______/ ______/ ______/ O Yes / O No
______/____/_____ / ______/____/_____ / ______/ ______/ ______/ O Yes / O No
I hereby certify that all of the above information is true and correct. I understand that if my status changes from that which I have indicated on this form I must submit a new Foreign National Information form to the UHF Fiscal Office.
Signature:Local Phone Number:E-mail: Date:
Countries with Tax Treaties with United States
CountryMaximum Presence in U.S.Maximum amount
Belgium5 yearsNo limit
China, People’s Republic ofNo limitNo limit
Commonwealth of Independent States5 years$9,999 p.a.
Cyprus5 yearsNo limit
Czech Republic5 yearsNo limit
Egypt5 yearsNo limit
Estonia5 yearsNo limit
France5 yearsNo limit
GermanyNo limitNo limit
Iceland5 yearsNo limit
Indonesia5 yearsNo limit
Israel5 yearsNo limit
Kazakstan5 yearsNo limit
Korea, Republic of5 yearsNo limit
Latvia5 yearsNo limit
Lithuania5 yearsNo limit
LuxemborgNo limitNo limit
Morocco5 yearsNo limit
Netherlands3 yearsNo limit
Norway5 yearsNo limit
PakistanNo limitNo limit
Philippines5 yearsNo limit
Poland5 yearsNo limit
Portugal5 yearsNo limit
Romania5 yearsNo limit
Russia (grants, allowances & other similar payments)5 yearsNo limit
Slovak Republic5 yearsNo limit
Spain5 yearsNo limit
Thailand5 yearsNo limit
Trinidad and Tobago5 yearsNo limit
Tunisia (full-time student or trainee only)5 yearsNo limit
Venezuela5 yearsNo limit
UHF-F008 (06/05)