All applicable questions must be answered.

Personal Information

* - Required Fields

Status:	New Student Current Student Visiting Scholars
UDID #:
Last Name:
First Name:
Middle Name:
Date of Birth (yyyy/mm/dd):
Gender:	Male Female
Address (in your country):
U.S. Street Address:
U.S. City/State:
U.S. Zipcode (Postal Code):
Telephone (at present address):
E-mail Address:
Level:	Visiting Scholar PhD Masters Bachelors ELI
Department/Major at UD:

Emergency Contact Information (Required for new students)

Name of Emergency Contact in the US:
Address:
Telephone:
Relationship:
Name of Emergency Contact in Your Home Country:
Address:
Telephone:
Relationship:

By submitting this form, you are affirming that all of the information you have given is true, correct and complete.

 

IMPORTANT

TAX: If you wish to claim exemption from US income taxes because of your country of permanent residence has a tax treaty with the United States, you must complete IRS form 8233 and the appropriate revenue procedure. (Available through Payroll.)
INSURANCE: I understand that I am responsible for obtaining health insurance for myself and my dependents.

I hereby certify under the penalties of perjury that all 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 International Student & Scholar Information Request Form to the Office for International Students & Scholars.