Contact Information
Home Country Agency or Agent Code: *
*Enter 000 if you did not go through an agency or have an agent code.
US Sponsor: *
Surname/Family Name: *
First Name: *
Middle Name: *
Date of Birth (mm/dd/year): *
1 2 3 4 5 6 7 8 9 10 11 12
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Email Address: *
Confirm Email Address: *
Telephone Number (include country code): *
Home Country: *
Current Address: *
City: *
Postal Code: *
How did you hear about our service?: *
Agent
Website
Participant
Other
If other, please explain: *
Visa Information
Program Participant Year (Check all that apply): *
2008
2007
2006
2005
Program Type: *
Work & Travel
Intern
Trainee
Other
If other, please explain: *
Visa Type: *
J1
F1
H1B
H2B
Q
L
E
P
O
Other
If other, please explain: *
Date of Arrival in US (mm/dd/year): *
1 2 3 4 5 6 7 8 9 10 11 12
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2004 2005 2006 2007 2008 2009 2010 2011 2012
Date of Departure from US (mm/dd/year): *
1 2 3 4 5 6 7 8 9 10 11 12
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2004 2005 2006 2007 2008 2009 2010 2011 2012
Have you applied for this refund before?: *
Yes
No
What program year did you file for?: *
2008
2007
2006
2005
2004
What was the amount of your tax refund?: *
What year did you receive your tax refund?: *
What company assisted you in filing your tax refund?: *
Employer Information
1st Company Name: *
Street Address: *
City: *
State: *
Telephone: *
Work Start Date (mm/dd/year): *
1 2 3 4 5 6 7 8 9 10 11 12
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2004 2005 2006 2007 2008 2009 2010 2011 2012
Work End Date (mm/dd/year): *
1 2 3 4 5 6 7 8 9 10 11 12
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2004 2005 2006 2007 2008 2009 2010 2011 2012
Supervisor Name: *
2nd Company Name: *
Street Address: *
City: *
State: *
Telephone: *
Work Start Date (mm/dd/year): *
1 2 3 4 5 6 7 8 9 10 11 12
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2004 2005 2006 2007 2008 2009 2010 2011 2012
Work End Date (mm/dd/year): *
1 2 3 4 5 6 7 8 9 10 11 12
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2004 2005 2006 2007 2008 2009 2010 2011 2012
Supervisor Name: *
Additional Information Filling out as much information as possible may help you receive a larger tax refund.
Cost of your program (in USD): *
Cost of your flight to the U.S. (in USD): *
While you were in the U.S., did you pay for any of the following in your home country? (Check all that apply): *
Insurance (vehicle, medical, home, etc) 1
Mobile telephone costs
Memberships (clubs, gyms, social, etc.)
Housing costs (rent, mortgage, etc.)
Transportation (car, motorbike, etc.)
Other
If other, please explain: *
Did you leave a job in your home country to participate in the program?: *
Yes
No
Did you return to that job when your program ended?: *
Yes
No
Did you have a permanent address in your home country?: *
Yes
No
Did you return to this address when your program ended?: *
Yes
No
Did you receive mail at your home address while in the US?: *
Yes
No
Are you entitled to vote in your home country?: *
Yes
No
Do you have a bank account in your home country?: *
Yes
No
Comments: *