UT Math Request for Visitor Authorization
(THIS FORM IS TO BE SUBMITTED 2 WEEKS PRIOR TO VISIT)
Check if you don't have a SSN.
Disclosure of your Social Security Number ("SSN") is required of you in order for The University of Texas at Austin to process your reimbursement, as mandated by State and Federal law. Further disclosure of your SSN is governed by the Public Information Act (Chapter 552 of the Texas Government Code) and other applicable law.
Name of Your Host:
Email of Your Host:
This information is very important.
Lack of proper work authorization may result in non-payment.
Country passport issued by:
WB/WT or Visa Waiver Program
of the USA
Green Card No.
Other, please specify
for questions about visa issues.
Non-Texas State Employee
Nature of Service
Other Professional Activities
Dates of Visit
Arrival Date :
Institution Name, Full Address and Department
Full Mailing Address for reimbursement (preferably home address/must include street address and zipcode)
Description of Services, Including the Title of Talk
Provided by Host
Time and Location of Talk:
Is this guest a job candidate?
Direct paid items are not allowed using state funded accounts
Other Direct Paid Items:
Specify Other Direct Paid Items:
For lodging arrangements, please contact your account manager.
If this request is late, please provide a short explanation to the Dean
Lodging Conf. #:
Name of Hotel:
Please type the characters you see in the picture above