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					                                                               GREEN CARD REQUEST FORM
  EMPLOYEE INFORMATION

  Employee Last Name                         First Name                               Middle Initial




  Department Name                            College                                  Position




  Date of hire                               Date of offer from Department            Employee Phone Number




                      st
  Date of issuance of 1 H1B or               Years of eligibility left on H1B or      Expiration date of current H1B or
  other status currently on                  other status currently on                other status currently on




  Direct Supervisor’s Name                   Title                                    Phone Number




  APPROVAL
  By signing below, I authorize the Human Resource and Legal and Office of Legal Affairs to beginning
By signing below, I authorize the Human Resource Department Departments to proceed with proceed
  the application for a green card green above the above mentioned I understand that this includes
with beginning the application for for the card formentioned employee. employee. I understand that this
includes providing an index for these fees, which have been estimated to be $5000 - $8000, in addition
  providing an account number for these fees, which have been estimated to be $4500 - $5000, in
   the $475 the fee charges, which are approximately $600.
toaddition tofilingfilingfor the I140 Immigrant Petiton.



  Dean / AVP Signature                       Dean / AVP Name Printed                  Date



                                              71108
  Index for fees to be charged to
  Account Number for fees to be charged to   Account
                                             Object Code




    Please forward the signed to Michael Dills.
Please forward the signed formform to MattAllen, either via e-mail (matthew.dills@utoledo.edu) with an electronic signature
                                                                    michael.allen2@utoledo.edu
                and from the e-mail account either of the Dean/AVP or through inter-campus mail at MS 205.

				
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