I-94 表格（超级清晰）

U.S Department of Justice Admission Number Welcome to the United States I-94 Arrival/Departure Record - Instructions This form must be completed by all persons except U.S.Citizens, returning resident aliens, aliens with immigrant visas, and Canadian Citizens visiting or in transit. Type or print legibly with pen in ALL CAPITAL LETTERS. Use English. Do not write on the back of this form. This form is in two parts. Please complete both the Arrival Record (Items 1 through 13) and the Departure Record (Items 14 through 17). When all items are completed, present this form to the U.S. Immigration and Naturalization Service Inspector. Admission Number I-94 Arrival Record 1. Family Name 2. First (Given) Name 3. Birth Date (Day/Mo/Yr) 5. Sex (Male or Female)4. Country of Citizenship 6. Passport Number 7. Airline and Flight Number 8. Country Where You Live 9. City Where You Boarded 10. City Where Visa was Issued 11. Date Issued (Day/Mo/Yr) 12. Address While in the United States (Number and Street) 13. City and State I-94 Departure Record 14. Family Name 15. First (Given) Name STAPLE HERESee Other Side Immigration and Naturalization Service 16. Birth Date (Day/Mo/Yr) 17. Country of Citizenship Form I-94 (04/06/00)Y Item 7 - If you are entering the United States by land, enter LAND in this space. If you are entering the United States by ship, enter SEA in this space. Departure Number OMB No. 1115-0077 OMB No. 1115-0077 OMB No. 1115-0077 The authority to collect this information is contained in Title 8 of the United States Code. Authority Paperwork Reduction Act Notice. A person is not required to respond to a collection of information unless it displays a currently valid OMB control number. The estimated average time to complete and file this application is 4 minutes per application. If you have comments regarding this form, you can write to the Immigration and Naturalization Service, HQPDI, 425 I Street N.W., Room 4307r, Washington DC 20536; OMB No. 1115-0077. DO NOT MAIL YOUR COMPLETED APPLICATION TO THIS ADDRESS. A nonimmigrant who accepts unauthorized employment is subject to deportation. Retain this permit in your possession; you must surrender it when you leave the U.S. Failure to do so may delay your entry into the U.S. in the future. Primary Inspection Applicant's Name Date TimeReferred Insp. # Reason Referred PP Visa TWOV212A Parole SLB Other Secondary Inspection End Secondary Time Insp. # Disposition 18. Occupation 19. Waivers 20. INS File A- 21. INS FCO 22. Petition Number 23. Program Number 25. 26. Itinerary/Comments 27. TWOV Ticket Number Students planning to reenter the U.S. within 30 days to return to the same school, see "Arrival-Departure" on page 2 of Form 1-20 prior to surrendering this permit. Record of Change Departure RecordPort: Date: Carrier: Flight # / Ship Name: 24. Bond Prospective Student Warning - Important - You are authorized to stay in the U.S. only until the date written on this form. To remain past this date, without permission from immigration authorities, is a violation of the law. Surrender this permit when you leave the U.S. - By sea or air, to the transportation line; - Across the Canadian border, to a Canadian Official; - Across the Mexican border, to a U.S. Official.