UT Math Request for Visitor Authorization


Today's Date: 05/30/2023

Visitor's Name:  Academic Title:
(if you have one)

If you don't have an UT EID, you will receive an email from dse@docusign.net to establish a UT EID.
You'll need to upload your identification or social security card as an attachment and sign the Payee Information Form (PIF) electronically.

    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:
   WB/WT or Visa Waiver Program
  Permanent Resident
  of the USA
   Green Card No.
  Other, please specify 
Please see Russ (rwoodward@austin.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