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:
- S. Government Agency $______________ per month__ year __ other ________
- International Organization $______________ per month__ year __ other ________
- Exchange Visitor’s Government $______________ per month__ year __ other ________
- Fulbright Comm. $______________ per month__ year __ other ________
- Other Organization $______________ per month__ year __ other ________
- 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
- 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 ______________