J1 visa Procurement Form for Colleges and Departments

Office of International Programs – University of Illinois Springfield

Request for Procurement of J-1 Exchange Visitor Document DS2019

To Be Completed by Sponsoring Department/College

All Information Requested is Essential Unless Otherwise Indicated

The Department/College of ____________________________ proposes to sponsor the following individual as an Exchange Visitor:

  • Family Name ________________________First____________________Middle_____________
  • Title of address: Dr.__ Prof. __ Mr. __ Ms. __
  • Married: Yes __ No __
  • Male __ Female __
  • Date of Birth: M/D/Year __/__/____
  • City of Birth: ___________________
  • Province/State of Birth: __________________
  • Country of Birth: ____________________
  • Legal Permanent Resident of: _______________________________ (not necessarily the country in which he/she resides. Please confirm.
  • Alien’s current mailing address: ______________________________________________________________________________
  • Alien’s E-mail address (if applicable): ______________________________________
  • Alien’s Telephone Number(s): __________________________________________
  • Number of dependents (j2s) accompanying visitor (only spouse and children under 21 qualify): _________________

Visitor is responsible for the expenses of the dependents.

  • Current position title and employing institution in country of legal permanent residence. If not employed, say so. If a student, give level of study and name of educational institution. _____________________________________________________________________________
  • Initial visit period from: M/D/Year __/__/____ to M/D/Year __/__/____
  • Proposed activity at UIS: Research __ Teaching __ Other _______________________
  • Title of proposed UIS position: Visiting Scholar __ Postdoctoral Research Associate __   Other ______________   NOTE: the J1 visa may not be used for tenure-track positions.
  • Specialized fields(s) of activity at UIS: ______________________________________________
  • Estimated financial support to the alien from all sources for the period specified in # 15:

Minimum acceptable amounts of monthly support not to include airfare are $1000 per month for the J1 and an additional $500 per month for the spouse and $250 per month per child

UIS funding: $____________________ per month __ year __ other ________________

Is UIS funding coming from any government agency? Yes __ No __

If yes, is funding specifically designated for international exchange? Yes __ No __

If yes, name of Agency: ______________________________________

Non-UIS funding direct to alien from:

  1. S. Government Agency $______________ per month__ year __ other ________
  2. International Organization $______________ per month__ year __ other ________
  3. Exchange Visitor’s Government $______________ per month__ year __ other ________
  4. Fulbright Comm. $______________ per month__ year __ other ________
  5. Other Organization $______________ per month__ year __ other ________
  6. Personal Funds* $______________ per month__ year __ other ________

Attach official verification from funder to confirm amounts and dates of funding. Personal funds must be verified via bank statements and notarized statements of funder if not self.

  • Department/College contact: ______________________________________

Address _________________________________________Phone ________________

Fax ________________________ E-mail _____________________________

  • Has the alien been in the U.S in J1 or J2 status at any time during the last 12 months?

Yes __ No __         if yes, please attach copies of all DS2019 forms relating to that J program.

  • Is this person in the U.S. at present?

Yes __                                        State type of status, such as H1, F1, etc. _____________

Attach copies of his/her I94 and relevant visa papers (copy of passport, visa, and DS2019, I20 for example)

Check One:         __ will leave U.S. and reenter in J1 status.

__ will remain in the U.S. and change status or transfer from other J program

No __

 

 

  • For accompanying J2 dependents:
Name (family, first, middle) Relationship Date of Birth (M/D/Year) Place of Birth   City/Province/Country Country of Legal Permanent Residence
         
         
         
         

 

  • Please attach a description of the proposed research or teaching activity, etc.:

 

  • The credentials of this prospective exchange visitor have been evaluated. He/she has a minimum of a bachelor’s degree plus experience in the field and is considered to be qualified to pursue the objectives described. Yes __ No __
  • Language Assessment:

Check one:          __ N/A. English is his/her first language.

__ Visit will be for no more than one month. English assessment not required.

__ I have determined that _____________________ has sufficient English language proficiency to enable him/her to successfully carry out the activities described above and to have an enriching cross-cultural experience. His/her language ability has been determined by the following method:

__ Previous interactions with visitor.

__ Personal interview/telephone conversation

__ Written communication

__ Other __________________________

I will help this individual accomplish the objectives of his/her J program. I understand that he/she must consult with the Office of International Programs before making any changes in the activities described on this form. I understand that the regulations of the J1 program restrict this individual’s employment possibilities and that his/her options for taking classes are limited. I understand that I am responsible for submitting a bi-monthly report on the visiting faculty member/research scholar to the Office of International Programs.

I confirm that I have read the Hosting visiting international faculty/scholars for extended stays document prepared by the Office of International Programs and understand my responsibilities and those of OIP.

Signature of host __________________________________________   Date ____________

Name of host ______________________________________________ Phone ____________

Campus Address ____________________________________________ Email _____________

Signature the host’s Dean or Supervisor__________________________ Date ______________