Cordell Hull Foundation J-1 Teacher ROSTER FORM
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This form is for the school staff to fill out. Teachers: Do not fill out this form.
NOTE: The Yahoo Interactive Server is currently out of order. Until corrected, please print out your confirmation after clicking on the SUBMIT button at the bottom. Then fax the confirmation to 646-349-3455, a USA digital fax number operational 24 /7. Thank you.
Be sure to spell name exactly as written on the passport. Fill in all blank spaces.
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Upon completing the form, check all data carefully for accuracy.
Then click on the "Submit form" button on the bottom of the page.
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US State where teacher will
work
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Initial
Date of arrival in the US
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End
date of J-1 visa term
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First Name as written
in passport
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Middle Name as
written in passport
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Last Name as written
in passport
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Date of birth
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Sex
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Year
of participation in the CHF Exchange
Teacher Program
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City of Birth
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Country of Birth
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Country of
Citizenship
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Country of Legal
Residence
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Passport Number
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Country of Passport
Issuance
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Home Address in the
country of origin
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Address in the US (or school/ school
district address)
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Level
that teacher will teach
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Name of PERSON completing this form
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E-mail address of PERSON completing this form
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Annual
Salary in US Dollars
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Subject
to be
taught
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Number of J-2
family members
spouse:
children: |
Teacher's Contact
Phone in the country of origin
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Teacher's email address
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School or
District contact person's name and phone no.
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