[University of Maryland College Park logo]
International Student & Scholar Services
1126 HJ Patterson Hall, College Park, MD 20742
301-314-7740
isss.umd.edus


Visa Data Collection Form 


Name as it Appears in your Passport:
  Family/Last:
  Name Given/First Name(s):
  Middle Name:

Date of Birth (MM/DD/YYYY):

Sex (M/F):

Country of Citizenship:

Country of Permanent Residence:

Foreign Address:
  Street Address: 
  City, State/Province:
  Postal Code Country:

Foreign Phone Number:

Email Address:

University of Maryland Faculty Host/Supervisor Name:

Foreign Employer or Affiliated Institution Name:

Foreign Employer or Affiliated Institution Address:

I am conducting research in:

Fill in this chart with information about [financial support](https://globalmaryland.umd.edu/offices/international-student-scholar-services/j-1-funding-guide) for your visit to the University of Maryland.

Source of Funding
  University of Maryland:
  Home Government/Institution:
  Personal/Family Funds:
  Other:

Amount of Funding
  University of Maryland:
  Home Government/Institution:
  Personal/Family Funds:
  Other:

Required Documentation
  University of Maryland: No documentation required
  Home Government/Institution: Letter from the government/institution detailing the period of time that funding covers and the amount of funding.
  Personal/Family Funds: Bank statements or other documents verifying financial support.
  Other:


For Department/Faculty Supervisor Use Only

Field of Study:
Browse fields of study [here](Browse fields of study here.).

Site(s) of Activity:

Purpose of research: