B1, B2, VWB INTERNATIONAL VISITOR STATEMENT
Visitor Information
Name*
(please type or print clearly in ink)
Family or Surname
First
Middle
*Please print your name as it appears on your passport.
[ ] Male
[ ] Female
Date of Birth
month/day/year
Place of Birth
City
Country of Citizenship
Country
Country of Residence
(If more than one, which passport do you plan to come to the US on?_____________________________
Mailing Address
Telephone
Email
Current Occupation (title, field)*
*For example, Professor of Political Science; or, Researcher in the Field of Economics
Current Employer
Country of current legal permanent residence if different from above_____________________________
Do you have a U.S. Social Security Number (SSN) or Individual Tax Identification Number (ITIN)? (Note
that beginning in 2013, new ITIN’s will expire after 5 years. SSN’s do not expire.)
Yes______
No______
If you plan to enter the US in B-1 B-2 or VWB Visitor status, please complete the following:


Will your stay at Puget Sound last longer than nine days? Yes _____ No _____
Will you receive honoraria payments from more than five academic institutions in the sixmonth period prior to your visit to Puget Sound?
Yes _____ No ________
This form must be accompanied by photocopies of the following documents:
[ ] copy of passport ID page
[ ] copy of visa(s) page(s) in passport, if applicable
[ ] arrival stamp (after arrival to US)
Return this form and supporting documents as soon as possible to:
Allyson Lindsley
alindsley@pugetsound.edu
Office of International Programs
University of Puget Sound
1500 N. Warner #1055
Tacoma, WA 98416-1055, USA