<table style="width:100%;">
<colgroup>
<col style="width: 24%" />
<col style="width: 1%" />
<col style="width: 6%" />
<col style="width: 3%" />
<col style="width: 14%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 8%" />
<col style="width: 3%" />
<col style="width: 16%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="15"><p><strong>U.S. DEPARTMENT OF AGRICULTURE</strong></p>
<p><strong>FOREIGN NATIONAL DATA SHEET</strong></p></td>
</tr>
<tr class="even">
<td><strong>SECTION I</strong> <em>(REQUIRED)</em></td>
<td colspan="11"><p>(USDA Office Use Only)</p>
<p> NEW REQUEST UPDATE/CHANGE</p></td>
<td colspan="3">(ARS Office Use Only)</td>
</tr>
<tr class="odd">
<td colspan="15">NAME (<em>Family Name, First and Middle Name with no
abbreviations)</em>:</td>
</tr>
<tr class="even">
<td colspan="8">OTHER SURNAMES USED (<em>Maiden, Religious,
Professional, Aliases)</em>:</td>
<td colspan="7">OTHER FIRST OR MIDDLE NAMES USED:</td>
</tr>
<tr class="odd">
<td colspan="2">DATE OF BIRTH (<em>MM/DD/YYYY</em>):</td>
<td colspan="5">PLACE OF BIRTH (<em>City &amp; Country)</em>:</td>
<td colspan="6">CITIZENSHIP OR NATIONALITY:</td>
<td colspan="2">MARITAL STATUS:</td>
</tr>
<tr class="even">
<td colspan="2">SEX: MALE FEMALE</td>
<td colspan="5">COUNRTRY OF RESIDENCE:</td>
<td colspan="8">PASSPORT COUNTRY <em>(If you do not yet have one, the
country that will issue it)</em>:</td>
</tr>
<tr class="odd">
<td colspan="15">HOME ADDRESS <em>(include apartment or house number,
street, city, state or province, postal code, and country)</em>:</td>
</tr>
<tr class="even">
<td colspan="6">HOME TELEPHONE NUMBER:</td>
<td colspan="9">MOBILE/CELLULAR TELEPHONE NUMBER:</td>
</tr>
<tr class="odd">
<td colspan="6">FACSIMILE (FAX) NUMBER:</td>
<td colspan="9">E-MAIL ADDRESS:</td>
</tr>
<tr class="even">
<td colspan="15">RESIDENTIAL ADDRESSES IN OTHER COUNTRIES DURING THE
PAST 7 YEARS (Where did you live and how long did you live there):</td>
</tr>
<tr class="odd">
<td colspan="3"></td>
<td colspan="8"></td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td colspan="6">OCCUPATION <em>(If a student, write
“student”)</em>:</td>
<td colspan="9">NAME OF PRESENT EMPLOYER OR SCHOOL:</td>
</tr>
<tr class="odd">
<td colspan="15">EMPLOYER/SCHOOL’S ADDRESS:</td>
</tr>
<tr class="even">
<td colspan="6">EMPLOYER/SCHOOL’S TELEPHONE NUMBER:</td>
<td colspan="9">EMPLOYER/SCHOOL’S FAX NUMBER:</td>
</tr>
<tr class="odd">
<td colspan="15">IF YOU ARE A STUDENT WHAT IS YOUR SUBJECT OF
STUDY:</td>
</tr>
<tr class="even">
<td colspan="15">USDA FACILITY YOU WISH TO ACCESS <em>(Facility Name,
Address, Building Number, Room Number(s), City, State, and Zip
code)</em>:</td>
</tr>
<tr class="odd">
<td colspan="4">USDA HOST’S NAME:</td>
<td colspan="6">HOST’S TELEPHONE NUMBER:</td>
<td colspan="5">HOST’S E-MAIL ADDRESS:</td>
</tr>
<tr class="even">
<td colspan="15">PURPOSE OF YOUR TRIP TO THE USDA FACILITY LISTED ABOVE
(One paragraph summary):</td>
</tr>
<tr class="odd">
<td colspan="5">DATE YOU EXPECT TO ARRIVE AT THIS FACILITY
<em>(MM/DD/YYYY)</em>:</td>
<td colspan="10">DATE YOU EXPECT TO DEPART THIS FACILITY
<em>(MM/DD/YYYY)</em>:</td>
</tr>
<tr class="even">
<td colspan="5">WHO WILL FUND THIS TRIP:</td>
<td colspan="10"><p>AMOUNT PROVIDED <em>(in U.S. Dollars)</em>:</p>
<p>$</p></td>
</tr>
<tr class="odd">
<td colspan="15">WILL ANYONE ACCOMPANY YOU ON THIS TRIP?: NO YES <em>(if
yes, please complete the following questions for each person</em>)</td>
</tr>
<tr class="even">
<td colspan="4">First, Middle and Last Name</td>
<td colspan="5">Birth Date <em>(MM/DD/YYYY)</em>:</td>
<td colspan="5">Place of Birth <em>(City &amp; Country)</em></td>
<td>Relationship</td>
</tr>
<tr class="odd">
<td colspan="4"></td>
<td colspan="5"></td>
<td colspan="5"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="4"></td>
<td colspan="5"></td>
<td colspan="5"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="4"></td>
<td colspan="5"></td>
<td colspan="5"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="4"></td>
<td colspan="5"></td>
<td colspan="5"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="4"></td>
<td colspan="5"></td>
<td colspan="5"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="15">DO YOU CURRENTLY HAVE HEALTH INSURANCE ACCEPTED IN THE
U.S.: NO YES (Insurance is REQUIRED for Exchange Program participation.
Please see the U.S. Department of State’s website <a
href="http://exchanges.state.gov/education/jexchanges/administration.htm#insurance">state.gov</a>
for specific insurance requirements.)</td>
</tr>
<tr class="odd">
<td colspan="15">COMMENTS:</td>
</tr>
</tbody>
</table>

+-----------------------+-------+---+---+---+----------+---+----------------------+
| **SECTION II**        |       |   |   |   |          |   |                      |
| *(REQUIRED: if you do |       |   |   |   |          |   |                      |
| not yet know answers  |       |   |   |   |          |   |                      |
| to the questions      |       |   |   |   |          |   |                      |
| below, you will have  |       |   |   |   |          |   |                      |
| an opportunity to     |       |   |   |   |          |   |                      |
| provide them upon     |       |   |   |   |          |   |                      |
| arrival at the        |       |   |   |   |          |   |                      |
| facility listed in    |       |   |   |   |          |   |                      |
| Section I)*           |       |   |   |   |          |   |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| AT WHAT ADDRESS WILL  |       |   |   |   |          |   |                      |
| YOU STAY WHILE IN THE |       |   |   |   |          |   |                      |
| U.S. *(include the    |       |   |   |   |          |   |                      |
| apartment, house, or  |       |   |   |   |          |   |                      |
| building number,      |       |   |   |   |          |   |                      |
| street, city, state,  |       |   |   |   |          |   |                      |
| postal code, and      |       |   |   |   |          |   |                      |
| country)*:            |       |   |   |   |          |   |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| TELEPHONE NUMBER FOR  |       |   |   |   |          |   |                      |
| THE ADDRESS ABOVE:    |       |   |   |   |          |   |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| **Photocopies will be |       |   |   |   |          |   |                      |
| made of the documents |       |   |   |   |          |   |                      |
| listed below so       |       |   |   |   |          |   |                      |
| please ensure you     |       |   |   |   |          |   |                      |
| have them with you    |       |   |   |   |          |   |                      |
| upon arrival**        |       |   |   |   |          |   |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| PASSPORT NUMBER:      |       | C |   |   |          | E |                      |
|                       |       | O |   |   |          | X |                      |
|                       |       | U |   |   |          | P |                      |
|                       |       | N |   |   |          | I |                      |
|                       |       | T |   |   |          | R |                      |
|                       |       | R |   |   |          | A |                      |
|                       |       | Y |   |   |          | T |                      |
|                       |       | O |   |   |          | I |                      |
|                       |       | F |   |   |          | O |                      |
|                       |       | I |   |   |          | N |                      |
|                       |       | S |   |   |          | D |                      |
|                       |       | S |   |   |          | A |                      |
|                       |       | U |   |   |          | T |                      |
|                       |       | E |   |   |          | E |                      |
|                       |       | : |   |   |          | * |                      |
|                       |       |   |   |   |          | ( |                      |
|                       |       |   |   |   |          | M |                      |
|                       |       |   |   |   |          | M |                      |
|                       |       |   |   |   |          | / |                      |
|                       |       |   |   |   |          | D |                      |
|                       |       |   |   |   |          | D |                      |
|                       |       |   |   |   |          | / |                      |
|                       |       |   |   |   |          | Y |                      |
|                       |       |   |   |   |          | Y |                      |
|                       |       |   |   |   |          | Y |                      |
|                       |       |   |   |   |          | Y |                      |
|                       |       |   |   |   |          | ) |                      |
|                       |       |   |   |   |          | * |                      |
|                       |       |   |   |   |          | : |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| VISA TYPE:            |       | V |   |   |          | E |                      |
|                       |       | I |   |   |          | X |                      |
|                       |       | S |   |   |          | P |                      |
|                       |       | A |   |   |          | I |                      |
|                       |       | # |   |   |          | R |                      |
|                       |       | : |   |   |          | A |                      |
|                       |       |   |   |   |          | T |                      |
|                       |       |   |   |   |          | I |                      |
|                       |       |   |   |   |          | O |                      |
|                       |       |   |   |   |          | N |                      |
|                       |       |   |   |   |          | D |                      |
|                       |       |   |   |   |          | A |                      |
|                       |       |   |   |   |          | T |                      |
|                       |       |   |   |   |          | E |                      |
|                       |       |   |   |   |          | * |                      |
|                       |       |   |   |   |          | ( |                      |
|                       |       |   |   |   |          | M |                      |
|                       |       |   |   |   |          | M |                      |
|                       |       |   |   |   |          | / |                      |
|                       |       |   |   |   |          | D |                      |
|                       |       |   |   |   |          | D |                      |
|                       |       |   |   |   |          | / |                      |
|                       |       |   |   |   |          | Y |                      |
|                       |       |   |   |   |          | Y |                      |
|                       |       |   |   |   |          | Y |                      |
|                       |       |   |   |   |          | Y |                      |
|                       |       |   |   |   |          | ) |                      |
|                       |       |   |   |   |          | * |                      |
|                       |       |   |   |   |          | : |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| U.S. EMBASSY OR       |       |   |   |   |          |   |                      |
| CONSULATE LOCATION    |       |   |   |   |          |   |                      |
| WHERE THIS VISA WAS   |       |   |   |   |          |   |                      |
| ISSUED *(City &       |       |   |   |   |          |   |                      |
| Country)*:            |       |   |   |   |          |   |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| DATE OF ENTRY INTO    |       | U |   |   |          |   |                      |
| U.S.:                 |       | . |   |   |          |   |                      |
|                       |       | S |   |   |          |   |                      |
|                       |       | . |   |   |          |   |                      |
|                       |       | P |   |   |          |   |                      |
|                       |       | O |   |   |          |   |                      |
|                       |       | R |   |   |          |   |                      |
|                       |       | T |   |   |          |   |                      |
|                       |       | O |   |   |          |   |                      |
|                       |       | F |   |   |          |   |                      |
|                       |       | E |   |   |          |   |                      |
|                       |       | N |   |   |          |   |                      |
|                       |       | T |   |   |          |   |                      |
|                       |       | R |   |   |          |   |                      |
|                       |       | Y |   |   |          |   |                      |
|                       |       | * |   |   |          |   |                      |
|                       |       | ( |   |   |          |   |                      |
|                       |       | C |   |   |          |   |                      |
|                       |       | i |   |   |          |   |                      |
|                       |       | t |   |   |          |   |                      |
|                       |       | y |   |   |          |   |                      |
|                       |       | & |   |   |          |   |                      |
|                       |       | S |   |   |          |   |                      |
|                       |       | t |   |   |          |   |                      |
|                       |       | a |   |   |          |   |                      |
|                       |       | t |   |   |          |   |                      |
|                       |       | e |   |   |          |   |                      |
|                       |       | ) |   |   |          |   |                      |
|                       |       | * |   |   |          |   |                      |
|                       |       | : |   |   |          |   |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| WHAT IS YOUR          |       |   |   |   |          |   |                      |
| IMMIGRATION STATUS?   |       |   |   |   |          |   |                      |
| (if checking a box    |       |   |   |   |          |   |                      |
| with more than one    |       |   |   |   |          |   |                      |
| choice listed please  |       |   |   |   |          |   |                      |
| also circle the       |       |   |   |   |          |   |                      |
| applicable status):   |       |   |   |   |          |   |                      |
|                       |       |   |   |   |          |   |                      |
| NON-IMMIGRANT         |       |   |   |   |          |   |                      |
| ASY                   |       |   |   |   |          |   |                      |
| LEE/REFUGEE/TEMPORARY |       |   |   |   |          |   |                      |
| PROTECTED STATUS      |       |   |   |   |          |   |                      |
| (TPS)                 |       |   |   |   |          |   |                      |
| IMMIGRANT/LAWFUL      |       |   |   |   |          |   |                      |
| PERMANENT RESIDENT    |       |   |   |   |          |   |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| FORM I-94             |       | A |   |   |          |   |                      |
| (ARRIVAL-DEPARTURE    |       | D |   |   |          |   |                      |
| RECORD)#:             |       | M |   |   |          |   |                      |
|                       |       | I |   |   |          |   |                      |
|                       |       | T |   |   |          |   |                      |
|                       |       | T |   |   |          |   |                      |
|                       |       | E |   |   |          |   |                      |
|                       |       | D |   |   |          |   |                      |
|                       |       | U |   |   |          |   |                      |
|                       |       | N |   |   |          |   |                      |
|                       |       | T |   |   |          |   |                      |
|                       |       | I |   |   |          |   |                      |
|                       |       | L |   |   |          |   |                      |
|                       |       | D |   |   |          |   |                      |
|                       |       | A |   |   |          |   |                      |
|                       |       | T |   |   |          |   |                      |
|                       |       | E |   |   |          |   |                      |
|                       |       | : |   |   |          |   |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| I-20/DS-2019          |       | I |   |   |          | E |                      |
| (CERTIFICATES OF      |       | - |   |   |          | X |                      |
| ELIGIBILITY)          |       | 2 |   |   |          | P |                      |
|                       |       | 0 |   |   |          | I |                      |
| PREPARED BY (Program  |       | / |   |   |          | R |                      |
| Sponsor and Number):  |       | D |   |   |          | A |                      |
| h                     |       | S |   |   |          | T |                      |
|                       |       | - |   |   |          | I |                      |
| (Box 2 information:   |       | 2 |   |   |          | O |                      |
| I-20 School name and  |       | 0 |   |   |          | N |                      |
| Code)                 |       | 1 |   |   |          | D |                      |
|                       |       | 9 |   |   |          | A |                      |
|                       |       | # |   |   |          | T |                      |
|                       |       | : |   |   |          | E |                      |
|                       |       |   |   |   |          | * |                      |
|                       |       | ( |   |   |          | ( |                      |
|                       |       | L |   |   |          | M |                      |
|                       |       | o |   |   |          | M |                      |
|                       |       | c |   |   |          | / |                      |
|                       |       | a |   |   |          | D |                      |
|                       |       | t |   |   |          | D |                      |
|                       |       | e |   |   |          | / |                      |
|                       |       | d |   |   |          | Y |                      |
|                       |       | i |   |   |          | Y |                      |
|                       |       | n |   |   |          | Y |                      |
|                       |       | t |   |   |          | Y |                      |
|                       |       | h |   |   |          | ) |                      |
|                       |       | e |   |   |          | * |                      |
|                       |       | t |   |   |          | : |                      |
|                       |       | o |   |   |          |   |                      |
|                       |       | p |   |   |          | ( |                      |
|                       |       | - |   |   |          | " |                      |
|                       |       | r |   |   |          | n |                      |
|                       |       | i |   |   |          | o |                      |
|                       |       | g |   |   |          | t |                      |
|                       |       | h |   |   |          | l |                      |
|                       |       | t |   |   |          | a |                      |
|                       |       | c |   |   |          | t |                      |
|                       |       | o |   |   |          | e |                      |
|                       |       | r |   |   |          | r |                      |
|                       |       | n |   |   |          | t |                      |
|                       |       | e |   |   |          | h |                      |
|                       |       | r |   |   |          | a |                      |
|                       |       | ) |   |   |          | n |                      |
|                       |       |   |   |   |          | " |                      |
|                       |       |   |   |   |          | o |                      |
|                       |       |   |   |   |          | n |                      |
|                       |       |   |   |   |          | I |                      |
|                       |       |   |   |   |          | - |                      |
|                       |       |   |   |   |          | 2 |                      |
|                       |       |   |   |   |          | 0 |                      |
|                       |       |   |   |   |          | o |                      |
|                       |       |   |   |   |          | r |                      |
|                       |       |   |   |   |          | " |                      |
|                       |       |   |   |   |          | T |                      |
|                       |       |   |   |   |          | o |                      |
|                       |       |   |   |   |          | " |                      |
|                       |       |   |   |   |          | o |                      |
|                       |       |   |   |   |          | n |                      |
|                       |       |   |   |   |          | D |                      |
|                       |       |   |   |   |          | S |                      |
|                       |       |   |   |   |          | - |                      |
|                       |       |   |   |   |          | 2 |                      |
|                       |       |   |   |   |          | 0 |                      |
|                       |       |   |   |   |          | 1 |                      |
|                       |       |   |   |   |          | 9 |                      |
|                       |       |   |   |   |          | ) |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| SOCIAL SECURITY OR    |       |   |   |   |          |   |                      |
| INDIVIDUAL TAXPAYER   |       |   |   |   |          |   |                      |
| IDENTIFICATION #:     |       |   |   |   |          |   |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| EMPLOYMENT            |       |   |   |   |          | E |                      |
| AUTHORIZATION #:      |       |   |   |   |          | X |                      |
|                       |       |   |   |   |          | P |                      |
|                       |       |   |   |   |          | I |                      |
|                       |       |   |   |   |          | R |                      |
|                       |       |   |   |   |          | A |                      |
|                       |       |   |   |   |          | T |                      |
|                       |       |   |   |   |          | I |                      |
|                       |       |   |   |   |          | O |                      |
|                       |       |   |   |   |          | N |                      |
|                       |       |   |   |   |          | D |                      |
|                       |       |   |   |   |          | A |                      |
|                       |       |   |   |   |          | T |                      |
|                       |       |   |   |   |          | E |                      |
|                       |       |   |   |   |          | * |                      |
|                       |       |   |   |   |          | ( |                      |
|                       |       |   |   |   |          | M |                      |
|                       |       |   |   |   |          | M |                      |
|                       |       |   |   |   |          | / |                      |
|                       |       |   |   |   |          | D |                      |
|                       |       |   |   |   |          | D |                      |
|                       |       |   |   |   |          | / |                      |
|                       |       |   |   |   |          | Y |                      |
|                       |       |   |   |   |          | Y |                      |
|                       |       |   |   |   |          | Y |                      |
|                       |       |   |   |   |          | Y |                      |
|                       |       |   |   |   |          | ) |                      |
|                       |       |   |   |   |          | * |                      |
|                       |       |   |   |   |          | : |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| ALIEN REGISTRATION    |       | G |   |   |          | E |                      |
| NUMBER (A# on your    |       | R |   |   |          | X |                      |
| Green Card):          |       | E |   |   |          | P |                      |
|                       |       | E |   |   |          | I |                      |
|                       |       | N |   |   |          | R |                      |
|                       |       | C |   |   |          | A |                      |
|                       |       | A |   |   |          | T |                      |
|                       |       | R |   |   |          | I |                      |
|                       |       | D |   |   |          | O |                      |
|                       |       | # |   |   |          | N |                      |
|                       |       | : |   |   |          | D |                      |
|                       |       |   |   |   |          | A |                      |
|                       |       |   |   |   |          | T |                      |
|                       |       |   |   |   |          | E |                      |
|                       |       |   |   |   |          | * |                      |
|                       |       |   |   |   |          | ( |                      |
|                       |       |   |   |   |          | M |                      |
|                       |       |   |   |   |          | M |                      |
|                       |       |   |   |   |          | / |                      |
|                       |       |   |   |   |          | D |                      |
|                       |       |   |   |   |          | D |                      |
|                       |       |   |   |   |          | / |                      |
|                       |       |   |   |   |          | Y |                      |
|                       |       |   |   |   |          | Y |                      |
|                       |       |   |   |   |          | Y |                      |
|                       |       |   |   |   |          | Y |                      |
|                       |       |   |   |   |          | ) |                      |
|                       |       |   |   |   |          | * |                      |
|                       |       |   |   |   |          | : |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| COMMENTS:             |       |   |   |   |          |   |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| **SECTION III**       |       |   |   |   |          |   |                      |
| (*complete this       |       |   |   |   |          |   |                      |
| section only if your  |       |   |   |   |          |   |                      |
| information has       |       |   |   |   |          |   |                      |
| changed               |       |   |   |   |          |   |                      |
| [while]{.underline}   |       |   |   |   |          |   |                      |
| at USDA)*             |       |   |   |   |          |   |                      |
|                       |       |   |   |   |          |   |                      |
| **If reporting a      |       |   |   |   |          |   |                      |
| change that involves  |       |   |   |   |          |   |                      |
| a document (i.e. a    |       |   |   |   |          |   |                      |
| new visa) please      |       |   |   |   |          |   |                      |
| provide it to your    |       |   |   |   |          |   |                      |
| Host for              |       |   |   |   |          |   |                      |
| photocopying**        |       |   |   |   |          |   |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| U.S. RESIDENCE        |       |   |   |   | CHANGE   |   |                      |
| ADDRESS CHANGE:       |       |   |   |   | OF HOME  |   |                      |
|                       |       |   |   |   | T        |   |                      |
|                       |       |   |   |   | ELEPHONE |   |                      |
|                       |       |   |   |   | NUMBER:  |   |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
|                       |       |   |   |   | E-MAIL   |   |                      |
|                       |       |   |   |   | ADDRESS  |   |                      |
|                       |       |   |   |   | CHANGE:  |   |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| EXTENSION OF A        |       |   |   |   |          |   | ##                   |
| VISA/I-20 OR DS-2019  |       |   |   |   |          |   | CURRENT EXPIRATION D |
| *(state the reason    |       |   |   |   |          |   | ATE *(MM/DD/YYYY)*:  |
| for extension)*:      |       |   |   |   |          |   |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
|                       |       |   |   |   |          |   | NEW EXPIRATION DATE  |
|                       |       |   |   |   |          |   | *(MM/DD/YYYY)*:      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| ## V                  | #     |   |   |   |          |   |                      |
| ISA TYPE CHANGED TO:  | # Sta |   |   |   |          |   |                      |
|                       | te th |   |   |   |          |   |                      |
| ## NEW VISA #:        | e rea |   |   |   |          |   |                      |
|                       | son f |   |   |   |          |   |                      |
|                       | or th |   |   |   |          |   |                      |
|                       | e cha |   |   |   |          |   |                      |
|                       | nge:  |   |   |   |          |   |                      |
|                       |       |   |   |   |          |   |                      |
|                       | ##    |   |   |   |          |   |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| SOCIAL SECURITY OR    |       |   |   |   |          |   |                      |
| INDIVIDUAL TAXPAYER   |       |   |   |   |          |   |                      |
| IDENTIFICATION #:     |       |   |   |   |          |   |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| IMMIGRATION STATUS    |       |   |   |   |          |   |                      |
| HAS CHANGED TO:       |       |   |   |   |          |   |                      |
| ASYLEE/REFUGEE LAWFUL |       |   |   |   |          |   |                      |
| PERMANENT RESIDENT    |       |   |   |   |          |   |                      |
| NATURALIZED CITIZEN   |       |   |   |   |          |   |                      |
|                       |       |   |   |   |          |   |                      |
| (checking             |       |   |   |   |          |   |                      |
| ASYLEE/REFUGEE please |       |   |   |   |          |   |                      |
| also circle which)    |       |   |   |   |          |   |                      |
| EFFECTIVE DATE        |       |   |   |   |          |   |                      |
| *(MM/DD/YYYY)*: l     |       |   |   |   |          |   |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| ALIEN REGISTRATION    |       |   | G |   |          |   | EXPIRATION DATE      |
| NUMBER (A# on your    |       |   | R |   |          |   | *(MM/DD/YYYY)*:      |
| Green Card):          |       |   | E |   |          |   |                      |
|                       |       |   | E |   |          |   |                      |
|                       |       |   | N |   |          |   |                      |
|                       |       |   | C |   |          |   |                      |
|                       |       |   | A |   |          |   |                      |
|                       |       |   | R |   |          |   |                      |
|                       |       |   | D |   |          |   |                      |
|                       |       |   | # |   |          |   |                      |
|                       |       |   | : |   |          |   |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| ANY CHANGE NOT LISTED |       |   |   |   |          |   |                      |
| ABOVE:                |       |   |   |   |          |   |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| **SECTION IV** *(for  |       |   |   |   |          |   |                      |
| USDA use only)*       |       |   |   |   |          |   |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| ACTUAL USDA ARRIVAL   |       |   |   | A |          |   |                      |
| DATE *(MM/DD/YYYY)*:  |       |   |   | C |          |   |                      |
|                       |       |   |   | T |          |   |                      |
|                       |       |   |   | U |          |   |                      |
|                       |       |   |   | A |          |   |                      |
|                       |       |   |   | L |          |   |                      |
|                       |       |   |   | U |          |   |                      |
|                       |       |   |   | S |          |   |                      |
|                       |       |   |   | D |          |   |                      |
|                       |       |   |   | A |          |   |                      |
|                       |       |   |   | D |          |   |                      |
|                       |       |   |   | E |          |   |                      |
|                       |       |   |   | P |          |   |                      |
|                       |       |   |   | A |          |   |                      |
|                       |       |   |   | R |          |   |                      |
|                       |       |   |   | T |          |   |                      |
|                       |       |   |   | U |          |   |                      |
|                       |       |   |   | R |          |   |                      |
|                       |       |   |   | E |          |   |                      |
|                       |       |   |   | D |          |   |                      |
|                       |       |   |   | A |          |   |                      |
|                       |       |   |   | T |          |   |                      |
|                       |       |   |   | E |          |   |                      |
|                       |       |   |   | * |          |   |                      |
|                       |       |   |   | ( |          |   |                      |
|                       |       |   |   | M |          |   |                      |
|                       |       |   |   | M |          |   |                      |
|                       |       |   |   | / |          |   |                      |
|                       |       |   |   | D |          |   |                      |
|                       |       |   |   | D |          |   |                      |
|                       |       |   |   | / |          |   |                      |
|                       |       |   |   | Y |          |   |                      |
|                       |       |   |   | Y |          |   |                      |
|                       |       |   |   | Y |          |   |                      |
|                       |       |   |   | Y |          |   |                      |
|                       |       |   |   | ) |          |   |                      |
|                       |       |   |   | * |          |   |                      |
|                       |       |   |   | : |          |   |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+
| COMMENTS:             |       |   |   |   |          |   |                      |
+-----------------------+-------+---+---+---+----------+---+----------------------+

**INSTRUCTIONS FOR FILLING OUT THE FORM ARS-230**

This form provides information for the system ARS uses to track facility
access and, when necessary for USDA's Foreign Agricultural Service (FAS)
or Forest Service International Programs to prepare a DS-2019
(Certificate of Eligibility for Exchange Visitor Status) to assist you
in obtaining a J-1 Visa at an U.S. Embassy or Consulate, and if
sponsored by FAS, to notify the Department of Homeland Security of
changes in your status. All foreign nationals desiring access to a
facility owned, operated, or controlled by USDA are required to complete
this form. The form should be completed by the individual requesting
access however circumstances may require someone else to complete the
form on their behalf. If you are preparing the form on behalf of someone
else, you must indicate this in the comment box at the bottom of Section
I. Most of the form's questions are self-explanatory and for others we
were able to provide clarification on the form. However, there are
additional questions which without additional information would remain
unclear. Explanations for those questions are addressed below.

Once you have completed Section I and if possible Section II, please
return this form to your prospective USDA host.

**Section I** - Information required by USDA and the FAS/Forest Service.

-   Name: your family or surname, first or given name (that name which
    distinguishes you from other members of your family) and complete
    middle name with no initials or abbreviations. If you have no middle
    name please indicate this by writing NMN (no middle name). If
    however your middle name is only an initial, please note this in
    parenthesis.

-   Country of Residence: the name of the country which has granted you
    permission to legally reside within its borders whether permanently
    or for a fixed period.

-   Marital status: please indicate if you are single (never married),
    married, divorced, separated, or widowed.

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-   USDA facility: the name of the research unit or office to which you
    are requesting access (when entering the facility's name, do not
    abbreviate anything other than USDA or ARS). If you are unsure of
    this information, the USDA employee with which you will study,
    visit, or work can provide this information to you.

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-   Expected USDA arrival/departure dates: the date you expect to arrive
    at this facility and the date you expect to leave it.

-   Purpose of your trip: a brief paragraph describing your intended
    activities at the facility.

**Sections II** - Information related to your entry into the United
States.

-   Visa Type: the category of visa that you were issued by the U.S.
    government such as a B1/B2. If you do not know, this information can
    be found on the right side of your visa under the heading Visa
    Type/Class.

> **Canadian Professional Workers:** if you are a citizen of Canada
> eligible for a [NAFTA Professional (TN)
> Visa](http://www.nafta-sec-alena.org/DefaultSite/index_e.aspx?DetailID=167#Ap1603.D.1)
> your I-94 Form (see below) is also your visa.
>
> **Visa Waiver Program (VWP) Participants:** if you are in the United
> States under the visa waiver program write "visa waiver program" or
> "VWP" where you are asked to put a visa number. If you are not from a
> visa waiver country and do not have a visa please explain in the
> comments section provided.
>
> **Lawful Permanent Residents:** do not put "Green Card" in this field
> (a separate section has been provided for this information). The Visa
> Type field is for information about the visa issued to you prior to
> gaining Lawful Permanent Resident status\--even if that visa is now
> expired.

-   Visa #: the 8-digit number in red on the lower right of the visa. If
    your visa was issued between

> October 1989 and January 1995 the number is located near the top of
> your visa centered in the blue border. If however, your visa was
> issued prior to October 1989 the number that appears at the top next
> to the word "No." is your visa number.

-   I-20/DS-2019 issued by: the name of the institution, organization,
    or company that requested the U.S. Department of State (State
    Department) to issue you a F-1 or J-1 Visa.

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-   I-94 #: You should have received this form (also called an Arrival
    -- Departure Form) upon arrival into the United States. The form
    contains an 11-digit number pre-printed in the upper left-hand
    corner. We ask that you provide the date you have been admitted
    until (listed on the form as Admitted Until). This form should also
    include your visa category listed as "CLASS".

-   Green Card: If you have not yet received your Form I-551 (Green
    Card) but a request is being processed please indicate this in the
    box that asks for the card number. If your card was issued before
    January 1998, it does not have a number; please write N/A in the
    number box. If it was issued between January 1977 and August 1989 it
    has neither a number nor an expiration date; please write N/A in the
    number and expiration date boxes. If it was issued after January
    1998 the number is etched into the card on the reverse. It appears
    in the lower-right corner just to the left of the card's designation
    number (I-551).

**Section III** -- Provided for personal information changes while at
USDA.

-   Changes to information provided previously in any section of the
    ARS-230 requires the submission of an amended form. The fields
    provided in this section are changes you are most likely to
    experience.

**PRIVACY ACT NOTICE**

We have asked you to provide information about yourself on this form in
accordance with United States Department of Agriculture polices. United
States laws give USDA specific legal rights to request this information.
We will not share your information with any other U.S. Government agency
except where required to process your request for access. Access to a
Government facility is a privilege not a right. Therefore, failure or
refusal to provide any of the information above may result in a denial
of access to USDA facilities, and in the case of participation in a
Government-sponsored program could result in the termination of your
participation in the program.

**PAPERWORK REDUCTION ACT NOTICE**

We have tried to create a form that can be easily understood with
instructions that provide additional information for questions that
might cause unnecessary confusion. Our intention is to collect required
information while imposing as little burden on you as possible.

We estimate the average time to complete this form after having gathered
the necessary documents will not exceed 30 minutes. You may experience
extraordinary circumstances which may require additional time to
complete the form. With this in mind, we have designed the form in such
a way that you may have two separate opportunities (prior to your
arrival in the U.S., and upon arrival at the facility) to complete it.
Additionally, we have provided a third section should your information
change while at our facility.

If you have any comments regarding the accuracy of our estimate or
suggestions for making this form simpler, please write to: Agricultural
Research Service, Attn: Forms Manager, 5601 Sunnyside Avenue, 2-1114A,
Beltsville, Maryland 20705-5141. Please include this form's title
"Foreign National Data Sheet" with your correspondence. **Please do not
send your completed form to this address.**