ࡱ> _a^` (bjbj 4T %lll8\L-XN"pppK W[-------$}.h06-)KK))6-ppK-d,d,d,)dpp-d,)-d,d,d,pL *pOl`*dd,-a-0-d,}1*<}1d,}1d,@"Rd,q$M&6-6-,d-))))ll LOYOLA COLLEGE FOREIGN NATIONAL INFORMATION FORM Check One:  FORMCHECKBOX  Initial Submission (Required prior to first payment)  FORMCHECKBOX  Update (Required only if information in Section B, C or D changes during individuals stay in U.S. SPECIAL NOTE FOR VISITORS ON J-VISAS: Ҵýors on J visas not sponsored by Ҵý College MUST obtain written permission from the International Office of the sponsoring institution PRIOR TO receiving honoraria or service payments from Ҵý College. SPECIAL NOTE FOR VISITIORS ON TN, H-1B OR O VISAS: Ҵýors on TN, H-1B or O visas not sponsored by Ҵý College may NOT receive honoraria or service payments from Ҵý College. A copy of your 1-94 Departure Record (a small white card inside your passport), a copy of your U.S. Visa from your passport, and a copy of your I-20, DS2019, IAP66 or I-797 (immigration documents), if applicable, must be attached to this form. Section A General Information 1. Last Name/Surname _______________________ Middle Initial _____ First Name/Given Name __________________ 2. U.S. Social Security Number or U.S. Individual Taxpayer Identification Number __________________________ 3. United States Address 4. Foreign Address Line 1 ______________________________ Line 1 _______________________________ Line 2 ______________________________ Line 2 _______________________________ Line 3 ______________________________ Line 3 _______________________________ City/Town __________________________ City/Town ___________________________ State _______________________________ Region/Province ______________________ Zip/Postal Code _______________________ Zip/Postal Code ______________________ Country _____________________________ 5. Telephone ________________________________ 6. Email Address ____________________________ Section B Residence Status for Tax Purposes Check the appropriate box below to indicate your residence status for tax purposes only. 7.  FORMCHECKBOX  I AM A PERMANENT RESIDENT Provide the alien number as shown on your Alien Registration Receipt Card. 8.  FORMCHECKBOX  I AM OR HAVE BEEN CLASSIFIED PREVIOUSLY AS A RESIDENT ALIEN FOR TAX PURPOSES. 9.  FORMCHECKBOX  I AM A NONRESIDENT ALIEN FOR TAX PURPOSES. I DO NOT meet the requirements for tax residence in the United States of America. 10. If you are a nonresident alien for tax purposes, what is your country of tax residency? ______________________ Note: If you checked Box 8 or 9 in this section you must complete Section C. Section C Passport and Visa Information 11. Visa Type Select One:  FORMCHECKBOX  B-1  FORMCHECKBOX  WB (Visa Waiver for Business)  FORMCHECKBOX  J-1 Research Scholar  FORMCHECKBOX  H-1B  FORMCHECKBOX  J-1 Student  FORMCHECKBOX  B-2  FORMCHECKBOX  WT (Visa Waiver for Tourism)  FORMCHECKBOX  J-1 Short Term Scholar  FORMCHECKBOX  TN  FORMCHECKBOX  F-1 Student  FORMCHECKBOX  Canadian Walk-over (no visa)  FORMCHECKBOX  J-1 Professor  FORMCHECKBOX  O-1  FORMCHECKBOX  Other, please specify: ____________________ 12. If you have an F, J, H, TN, O, L, P, A or G Visa, indicate the Sponsoring Institution listed on your immigration documents: ___________________________________________________ 13. Primary Purpose/Activity of Ҵý (select one):  FORMCHECKBOX  Studying in a degree program  FORMCHECKBOX  Consulting  FORMCHECKBOX  Conducting Research  FORMCHECKBOX  Studying in a non-degree program  FORMCHECKBOX  Teaching  FORMCHECKBOX  Acquiring Training  FORMCHECKBOX  Lecturing  FORMCHECKBOX  Clinical Activities  FORMCHECKBOX  Temporary Employment 14. Country Issuing Passport __________________________ Country of Citizenship _____________________ 15. Passport Number ________________________________ Visa Number (Red Number) ________________ Section D Visa Immigration Activity in The Last Six Calendar Years (Substantial Presence Test) 16. What is the actual date you entered the United States on your current visa? ______/______/______ Month Day Year 17. What is the start date and end date of your primary purpose/activity indicated on your current I-20, IAP66 or I-797 (immigration document)? Start Date: ______/______/______ End Date: ______/______/______ Month Day Year Month Day Year 18. Visa Immigration HistoryEnter all your visits to the United States (B-1/WB or B-2/WT Visa Holders do not need to complete this section). Note: F and J students do not need to document short vacations home during semester breaks. Did you take any Date of Entry Date of Exit Visa Type Primary Purpose/Activity Treaty Benefits? ___/___/___ ___/___/___ _________ _______________________  FORMCHECKBOX  Yes  FORMCHECKBOX  No ___/___/___ ___/___/___ _________ _______________________  FORMCHECKBOX  Yes  FORMCHECKBOX  No ___/___/___ ___/___/___ _________ _______________________  FORMCHECKBOX  Yes  FORMCHECKBOX  No ___/___/___ ___/___/___ _________ _______________________  FORMCHECKBOX  Yes  FORMCHECKBOX  No ___/___/___ ___/___/___ _________ _______________________  FORMCHECKBOX  Yes  FORMCHECKBOX  No ___/___/___ ___/___/___ _________ _______________________  FORMCHECKBOX  Yes  FORMCHECKBOX  No Section E Tax Treaty Exemption Information---IRS Forms 8233 and W-8BEN You must have a United States Social Security Number or Individual Taxpayer Identification Number to apply for a tax treaty benefit. Payments to nonresident aliens for services performed or benefits received within the U.S. may be subject to a maximum withholding tax rate of 30%. If you are a nonresident alien and believe that you may qualify for a tax treaty exemption, IRS forms 8233 or W-8BEN must be submitted with this completed Foreign National Information Form. IRS Forms 8233 or W-8BEN may be downloaded from the IRS website at  HYPERLINK "http://www.irs.gov/prod/forms_pubs/" www.irs.gov/prod/forms_pubs/ IRS Form 8233 is used by nonresident aliens to claim exemption from withholding on compensation for Independent Personal Services and some Dependent Personal Services. The exemption must be based on a tax treaty to which the United States is a party. Part I of the form must be filled out completely. The Ҵý College Disbursements Office will determine if the payee is eligible for the exemption per IRS regulations and College administrative procedures. The Ҵý College Disbursements Office will complete Part II of the form and apply for the exemption. A new Form 8233 must be submitted for each calendar year with the Foreign National Information Form annual update. IRS Form W-8BEN is used by nonresident aliens to claim exemption from withholding on other types of income (e.g. royalties, grants, scholarships, fellowships). Contact the Ҵý College Disbursements Office to determine if the Form W-8BEN is appropriate for the income being paid. The exemption must be based on a tax treaty to which the United States is a party. The form must be filled out completely. The Ҵý College Disbursements Office will determine if the payee is eligible for the exemption per IRS regulations and College administrative procedures. *** Certification I certify that all of the above information is true and correct. I understand that if my Passport and Visa Information or Residence Status for Tax Purposes changes, I must submit a new Foreign National Information Form reflecting the changes to: Disbursements Coordinator, Ҵý College, 4501 North Charles Street, Baltimore, MD 21210. 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PK. .  @UnknownGz Times New Roman5Symbol3& z Arial5& zaTahoma"1hUKFRfRfq;;/!4d 2QHX ??z:!FOREIGN NATIONAL INFORMATION FORM Anna Bivens Anna BivensOh+'0 ,8 X d p |$FOREIGN NATIONAL INFORMATION FORM Anna Bivens Normal.dot Anna Bivens26Microsoft Office Word@1@j-?@&@j-?՜.+,D՜.+,X hp  Ҵý College;  "FOREIGN NATIONAL INFORMATION FORM Title 8@ _PID_HLINKSA/KP$http://www.irs.gov/prod/forms_pubs/  !"#$%&'()*,-./012346789:;<=>?@ABCDEFGHIJKLMOPQRSTUWXYZ[\]`Root Entry FVwObData +U1Table5}1WordDocument4TSummaryInformation(NDocumentSummaryInformation8VCompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q