TEACHERS COLLEGE, COLUMBIA UNIVERSITY 525 WEST 120TH STREET NEW YORK, NY 10027 Addendum for Payment of Honorarium to a Non-Resident Alien Name: ______________________________________________________________________ Country of Citizenship: ___________________Country of Legal Residence: _______________ Address in Home Country: _______________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ US Visa Status (circle): B-1 B-2 WT/WB(visa waiver) Other (specify) ________ (may not be eligible to receive honorarium; contact International Services) Attach a copy of the recipient’s I-94 card (green or white card stapled in passport at US port-of- entry). **Director of Academic Administration, faculty member or Center Director must confirm and certify the following: _____The recipient is receiving an honorarium (and/or associated incidental expenses) for a usual academic activity (e.g., lecture, colloquium). _____ This activity will not last longer than nine (9) days at Teachers College. _____ The recipient has certified that s/he has not accepted such payment or expenses from more than five (5) institutions or organizations in the previous six-month period. Certified by: ______________________________________ (print) Dept: __________________ Signature:_____________________________________________________ If the recipient does not have a US Social Security number or ITIN (Individual Taxpayer Identification Number), attach a copy of the identity page of his/her passport (including passport number). **To ensure College compliance with ACWIA (American Competitiveness and Workforce Improvement Act) of 1998, which amended INA 212(q) to permit certain payments made by academic institutions to non-immigrants admitted to the United States under INA 101(a)(15)(B).