Cordell
Hull Foundation J-1 Teacher ROSTER FORM 2009
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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 it carefully and 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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Last Name as written
in your passport
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First
Name as written in your passport
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Middle Name as
written in your 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 you will teach
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E-mail
of the person completing this form
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Annual
Salary in US Dollars
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Subject that
will be
taught
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Contact
Phone in the country of Origin
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School/
District contact person's name and phone no.
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