Cordell Hull
Foundation J-1 Teacher ROSTER FORM 2010
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 This
form is for the school staff to fill out. Teachers: Do not
fill out this form.
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 to start working in 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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Teacher's Name |
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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