UT Math Request for Visitor Authorization
(THIS FORM IS TO BE SUBMITTED 2 WEEKS PRIOR TO VISIT)
Today's Date:
04/24/2024
Visitor's Name:
Academic Title:
UT EID:
(if you have one)
Email:
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:
H1-B
B1/B2
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