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Center for Immigration Services and Support

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Getting Started
Maintaining Your Status
International Employees and Scholars
ISS Staff
- The ISS Team

Center for Immigration Services and Support Announcement:

To make a request or find your I-20? Login to your ISSDeacs Account. To make an appointment with an Immigration Specialist? Sign up here.

For Updates and Information regarding recent relevant immigration changes see our News & Updates

Scholars
H-1B Summary
Medical Center

Medical Center

H-1B Information Sheet (Medical Center)

Last Name(Required)

First Name(Required)

Middle Name

Date of Birth(Required)

MM slash DD slash YYYY

Email

Current Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Foreign Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone (Work)

Phone (mobile)

Country of Birth

Country of Citizenship

State/Province of Birth

City of Birth

Passport Number

Date Passport Issued

MM slash DD slash YYYY

Date Passport Expires

MM slash DD slash YYYY

Issuing Country

If you are a new employee at Wake Forest or WFU Medical Center, please provide the estimated start date of your employment at Wake Forest University(Required)

Month

Day

Year

Official Position Title for WFU Medical Center Job

Sponsoring Department at WFU Medical Center

Base salary you will be receiving from WFU Medical Center (exclusive of bonuses, incentives, etc.)

Brief Summary of Duties involved in position(Required)

Please limit your response to 2-4 sentences maximum or 2-4 bullet points.

Are you currently in the U.S.?(Required)

Yes

No

Date of most recent arrival in the U.S. (date found on I-94 card)(Required)

MM slash DD slash YYYY

I-94 Number(Required)

Current nonimmigrant status (i.e. H-1B, J-1, F-1, etc.)(Required)

Expiration date of current nonimmigrant status(Required)

MM slash DD slash YYYY

Have you ever applied for a change of nonimmigrant status from the USCIS?(Required)

Yes

No

What type of status did you request?(Required)

Was the change of status approved?(Required)

Yes

No

Are you currently working in the U.S. on the optional practical training (OPT) program in conjunction with your F-1 status?(Required)

Yes

No

What is the expiration date listed on your employment authorization document (EAD card)?(Required)

MM slash DD slash YYYY

Are you currently working in the U.S. on the J-1 academic training program?(Required)

Yes

No

What is the end date for your period of academic training?(Required)

MM slash DD slash YYYY

Do you have any dependents who will be included in your H-1B application?(Required)

Yes

No

(If “yes,” you will need to complete Form I-539 and submit it to the WFU Center for Int’l Studies so that it can be submitted with the H-1 petition; please be mindful of the fact that this is considered to be a personal application and is not associated with WFU or WFU Medical Center)

Are you or any person included in the H-1B application, an applicant for an immigrant visa or adjustment of status to permanent residence?(Required)

Yes

No

Has an immigrant petition ever been filed for you or any other person included in the H-1B application?(Required)

Yes

No

Have you or any other person included in the H-1B petition ever been convicted of a criminal offense since last entering the U.S.?(Required)

Yes

No

Have you or any person listed in the H-1B application ever done anything that violated the terms of the nonimmigrant status you presently hold?(Required)

Yes

No

Are you currently classified as an H-1B nonimmigrant?(Required)

Yes

No

When were you first granted this classification?(Required)

MM slash DD slash YYYY

Please provide the petition receipt number from your last H-1B approval notice(Required)

What is the expiration date of your current H-1B status?(Required)

MM slash DD slash YYYY

If you are not currently classified as an H-1B nonimmigrant, have you ever held this classification in the past?(Required)

Yes

No

Please list the beginning and end date(s) of your H-1B status period(s) as depicted on the H-1B approval notice(s):(Required)

Are you currently residing in the U.S. in J-1/J-2 status or have you ever held this status in the past?(Required)

Yes

No

Are you subject or have you ever been subject to the two-year home residency requirement (212(e))?(Required)

Yes

No

Have you fulfilled or been granted a waiver of the requirement from the Department of State?(Required)

Yes

No

Are you currently employed in the U.S. in H-1B status by an employer other than WFU?(Required)

Yes

No

Name of your current employer(Required)

Type of employer (i.e. non-profit, university, governmental agency, private industry, etc.)(Required)

Official job title(Required)

Name of Department at WFU Medical Center with which you are/will be working(Required)

If you will be applying for an H-1 visa outside of the U.S., please provide the location of the U.S. Embassy/Consulate where you will be scheduling your visa interview

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