Name of person signing the declaration

What is your first name?

What is your last name?

What is your email address?

What is your mailing address?

What is your country of citizenship?

What is the number assigned to your application in the H-1B online lottery registration?

Please confirm you were not selected in the H-1B lottery for FY 2022.

I confirm I was not selected.

What is your current immigration status (e.g. F-1 student, visitor, not in the US, etc.)?