UT Math Request for Visitor Authorization
(THIS FORM IS TO BE SUBMITTED 2 WEEKS PRIOR TO VISIT)
Today's Date:
08/07/2022
Visitor's Name:
Academic Title:
SSN:
Email:
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:
US Citizen?
Yes
No
Visa Category
(non-citizen only)
This information is very important.
Lack of proper work authorization may result in non-payment.
J-1
Country passport issued by:
H1-B
B1/B2
WB/WT or Visa Waiver Program
Permanent Resident
of the USA
Green Card No.
Other, please specify
Please see
Elisa
(bass@math.utexas.edu)
for questions about visa issues.
Employment Status
Non-Texas State Employee
Federal Employee
Nature of Service
(check one)
Guest Lecturer
Continuting Education
Conference Participant
Student
Other Professional Activities
Dates of Visit
(MM/DD/YYYY)
Arrival Date :
Departure 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
Funding Source:
Time and Location of Talk:
Is this guest a job candidate?
Yes
No
Note:
Direct paid items are not allowed using state funded accounts
Direct Paid:
Lodging:
Yes
No
Other Direct Paid Items:
Yes
No
Specify Other Direct Paid Items:
For lodging arrangements, please contact your account manager.
Estimated Expenses
Fee:
Transportation:
Lodging:
Meals:
Other (specify)
If this request is late, please provide a short explanation to the Dean
Office Use
Lodging Conf. #:
Daily Rate:
Name of Hotel:
Total Fee:
Acct Title:
Transportation
Account #:
Lodging:
Acct Title:
Meals
Acct #:
Other
Estimated Total:
Specify Notes:
Please type the characters you see in the picture above