Address Update Form

Section 1: Personal, Academic, and Work Information

Enter full name in the fields below as it appears in your passport:

Exception: If you have only one name, please provide it in the Surname/Family Name field

Surname/Family name: *

Given name or names:

Date of birth:

Month

Day

Year

Country of birth:

Your current non-immigrant status:

Who issued your visa documents?

Duke

ECFMG

Other

Duke Unique ID

To find your Duke Unique ID, visit Duke OIT's Self Service website. If you do not have a Duke Unique ID, please contact your department to have one assigned. Duke University F-1 students on STEM extensions should select the "No" radio button and should not request a Duke Unique ID..

Do you have a Duke Unique ID?

Yes, I do have a Duke Unique ID.

No, I do not have a Duke Unique ID, but I will request one.

If you do not have a Duke Unique ID, please contact your department to have one assigned. Duke University F-1 students on STEM extensions should select the "No" radio button and should not request a Duke Unique ID.

Enter your Duke Unique ID

Duke Email Address

Please use a Duke e-mail, not a private vendor address such as Gmail or Yahoo. If you do not have a Duke e-mail address please contact your department to have one assigned.

Do you have a Duke email address? *

Yes, I do have a Duke email address.

No, I do not have a Duke email address, but I will request one.

If you do not have a Duke e-mail address please contact your department to have one assigned and select the "No" radio button.

Enter your Duke E-Mail Address

Non-Duke Email Address

All Duke students must use their Duke Email addresses while enrolled at Duke University. After graduation, students on F-1 Optional Practical Training or J-1 Academic Training must supply an alternate Non-Duke Email Address.

Enter your Non-Duke Email Address

Duke Enrollment Status

Are you a currently enrolled student at Duke?

Yes

School of enrollment:

Are you currently an employee, trainee, or visitor at Duke?

Yes

Work/Sponsoring department:

Work/Sponsoring Division (if any):

The U.S. Local Residential Address that you are Reporting/Updating

Address Line 1:

Address Line 2:

City

State

Zip Code

Phone

Cell Phone

Work Phone

Fax

Employment Information

If you are an F-1 student on Optional Practical Training or a J-1 student on Academic Training, the U.S. Department of Homeland Security requires you to report your employer's name and address.

Each time you change employers during Optional Practical Training or Academic Training, you must provide the following information:.

Are you currently unemployed?

Yes

Major Field of Study at Duke Was

Employment Start Date

Month

Day

Year

Employment End Date

Month

Day

Year

Employer Name

Physical address of your Worksite Line 1

Physical address of your Worksite Line 2

Worksite City

Worksite State

Worksite Zip Code

Supervisor’s Full Name

Supervisor’s Email

Supervisor's Phone

Are you Self Employed?

Yes

Employer Federal Employment Identification Number (FEIN)

Job Title

Are you in a Full-time (20 hours or more per week) position, or a Part-time position (less than 20 hours per week)?

Please provide a written explanation on how your employment relates directly to your field of study (1000 characters or less):

Proof of Funding: If your employment letter includes your salary, no additional information is required. If you are still seeking employment, are working unpaid or you are volunteering, we must have evidence of funding to cover your OPT living expenses. Send the proof of funding to the DVS Advisor who assisted you with your OPT application or Academic Training application.

Acknowledgment of Proof of Funding *

By checking this box, I acknowledge that I have read the Proof of Funding information above, and that I am aware of my responsiblity.

Are you in J-1 status?

Yes

Section 2: J Exchange Visitor Insurance Verification

Please review the J Health Insurance requirements.

After you have read the insurance requirements, answer the following questions.

1. Do you have health insurance for yourself and all of your J-2 dependents that meets the requirement?

Yes

2. Do you have medical evacuation insurance for yourself and all of your J-2 dependents that meets the requirement?

Yes

3. Do you have repatriation of remains insurance for yourself and all of your J-2 dependents that meets the requirement?

Yes

If you answered "no" to any of these questions, please contact Duke Visa Services (613-5654) to discuss how to obtain proper insurance. Willful failure to maintain the required health, medical evacuation, and repatriation of remains insurance for you and your dependents is a violation of your J Exchange Visitor status and can terminate your participation in the program.

Section 3: Affirmation of Accuracy

Affirmation of Accuracy *

By this submission of this form, I confirm that the information I have entered is true, complete, and correct.

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Duke Unique ID

Duke Email Address

Non-Duke Email Address

Duke Enrollment Status

The U.S. Local Residential Address that you are Reporting/Updating

Employment Information

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