Services for International Students and Scholars
University of California, Davis
http://siss.ucdavis.edu
(T) 530-752-0864
(F) 530-752-5822
siss@ucdavis.edu
E3/O1/TN SCHOLAR PERSONAL DATA SHEET
Today’s Date:
CURRENT INFORMATION
Name:
Male
Family (Last)
First
Country of Birth:
Is family here now?
Yes
No
Date first granted E/O/TN status:
Female
Middle
Date of birth:
If “No,” will family join you later?
Current Expiration Date:
mm/dd/yy
mm/dd/yy
Yes
No
mm/dd/yy
Spouse, and Children under 21 years of age, who accompanied you or will be visiting you (names & ages)
Family (Last) Name:
First Name:
Date of Birth
Citizenship
Current address in California
Street Number
Street Name
Phone Number with Area Code
Personal Email:
UCD Email :
Home or
Apartment Number
City
Cell
Postal Zip Code
Office/Lab Phone
HOME COUNTRY ADDRESS
Street Line 1:
Street Line 2:
State/Province:
City:
Postal Code:
Country:
PERSON TO BE NOTIFIED IN CASE OF AN EMERGENCY
Name:
Address:
Phone number:
Relationship:
E-mail address:
INFORMATION ABOUT SUPERVISOR
Name:
Campus Address:
Phone number:
Job Title:
E-mail address:
INFORMATION ABOUT DEPARTMENT CONTACT (department person in charge of international scholars)
Name:
Campus Address:
Phone number:
Rev Apr 2014
E-mail address: