Summary: Rev. Oct. 2003
UNIVERSITY OF HOUSTON
Please attach the forms requested (i.e. visa, passport, etc.).
1 . Name: List full name.
2 . Social Security Number: Enter U.S. social security number issued by the U.S. Social Security
Administration (not your UH ID number). Do not list numbers not assigned by the U.S. Social
Security Administration,(i.e. Canadian social security number). All employees must have a social
security number in order to work. If you don't have a number, enter your ITIN issued by the IRS.
3 . Empl ID: UH employees ID number assigned by Peoplesoft software.
4 . Local Street Address: List your local U.S. address.
5 . Foreign Residence Address: List your non U.S. address.
6 . Country of Tax Residence: Enter the country where you pay taxes.
7 . Country That Issued Passport: List Country in which you were issued your passport.
8 . Passport Number: Enter your passport number.
9 . Visa Number: Enter your Visa number. (The RED number, not the control number.)
10 . Immigration Status: Check yes or no. If yes, complete line 21 on page 2 (Prior U.S. Immigration Activity)
for the time you were present in the United States. Approximate if you do not know exact dates.
11 . Immigration Status: Check the type of immigration status that you currently hold. If you
check "U.S. Immigrant/Permanent Resident", holder of a "green card", you may proceed to
the bottom of page 2. Sign and date the form.