J-1 EXCHANGE VISITOR DEPARTMENT REQUEST FORM

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1 J-1 EXCHANGE VISITOR DEPARTMENT REQUEST FORM For issuance of SEVIS Form DS-2019, Certificate of Eligibility for J-1 Visa Application The purpose of the J-1 Exchange Visitor Program, which is administered by the U.S. Department of State, is to increase mutual understanding between the people of the United States and the people of other countries by means of educational and cultural exchanges. The International Student and Scholar Services (ISSS) Office is authorized by the U.S. government to manage the J-1 Exchange Visitor Program at San José State University. This authorization carries with it the responsibility for assessing whether the program is associated with and of benefit to this University, whether the applicant is qualified, and whether there is sufficient financial support to cover expenses during the duration of the program. IMPORTANT NOTES: The ISSS Office is not the official approver of exchange visitor visits to SJSU. The ISSS role is to process the immigration document (Form DS-2019) required by the U.S federal government for the visiting scholar's J-1 visa application and entry to the U.S. Please be sure to contact the Office of Faculty Affairs to ensure compliance with university policies and procedures related to hosting J-1 visiting scholars in paid or unpaid research and teaching positions. This J-1 Exchange Visitor Request form must be submitted at least 3-4 months prior to the planned program start date at SJSU in order for the ISSS Office to have sufficient time to review the request and prepare the DS-2019 Forms and for the exchange visitor to have ample time to apply for the J-1 visa and make travel arrangements. SJSU Host Department Responsibilities In order to host an exchange visitor (EV) in the U.S. under the SJSU J-1 Exchange Program the host department must: Verify that the exchange visitor s academic credentials are appropriate to the proposed research/teaching program objectives. Verify that the exchange visitor has sufficient English proficiency (both oral and written) and provide documentation on how this determination was done (Interview, TOEFL scores). Arrange for office space deemed appropriate for the proposed activity. Inform ISSS of any changes to the exchange visitor s activity while at SJSU including termination of agreements. Mail the original DS-2019 Form(s) to the exchange visitor. The form cannot be scanned and sent by . Assist the exchange visitor in finding housing accommodation. Ensure the exchange visitor reports to the ISSS Office within 5 days of arrival to the U.S. in order to complete the ISSS immigration document check-in process, as required by the U.S. Department of State regulations. Assist ISSS in monitoring exchange visitor s maintenance of adequate health insurance coverage for the duration of the program. Arrange any University access request (i.e. Tower Card, library card, parking, etc.).

2 J-1 EXCHANGE VISITOR DEPARTMENT REQUEST FORM Application Process 1. The SJSU host department must collect all required information and documents from the exchange visitor to complete the J-1 Exchange Visitor Department Request Form. 2. Additional documentation must be submitted with the J-1 Exchange Visitor Department Request Form as follows: Photocopy of the passport biographical page of the exchange visitor and any accompanying dependent(s). Funding documents covering at least $2,000/ month for the exchange visitor, $1,000/month for the accompanying spouse, and $500/month for each accompanying child. Exchange visitor s resume or curriculum vitae Photocopy of the invitation/appointment/ offer letter issued by the SJSU sponsoring department. The program start and end dates on this form must be the same as the dates shown on the letter. Complete J-1 Exchange Visitor Certification of English Language Proficiency form and supporting documentation as applicable For questions regarding the process, please contact Katerina Salas-Natchova, Assistant Director of International Student and Scholar Advising (Katerina.salas@sjsu.edu) or Khim Lok (khim.lok@sjsu.edu), Office Coordinator. FOR INTERNATIONAL STUDENT & SCHOLAR SERVICES USE ONLY: Exchange Visitor Request Form Financial Documentation Passport o Primary o Dependents Copy of department invitation letter Copy of resume or curriculum vitae Certification of English Language Proficiency Date received: DS-2019(s) form Issued Contact Department for pick up

3 THIS SECTION MUST BE COMPLETED BY THE J-1 EXCHANGE VISITOR (VISITING SCHOLAR) ISSS must collect this information to process a J-1 visa certificate (Form DS-2019). Please complete all fields and answer all questions. 1. Biographical Information Family/ Last Name: First Name: Female: Date of Birth: Male: Month Day Year City of birth Country of Birth: Country of Citizenship: Country of Legal Permanent Residence: Foreign Address (in your country of legal permanent residence): Address: What is your position/occupation in your home country? (Professor, researcher, government official, private sector professional, etc.): Have you been in the U.S. as a J-1 status holder prior to this request? NO YES If YES, please provide photocopies of all previously issued DS-2019 Forms (or IAP-66 Forms) with this request. If you are currently in the U.S. in J-1 status, please also submit a photocopy of your J-1 visa and most recent Form I-94. Have you resided in your home country for 2 years since the end of your previous J-1 status? NO YES 2. Family/ Dependent Information Please list ONLY the family members that will accompany you to the U.S. in J-2 Exchange Visitor Dependent status and require a Form DS Family members who will NOT accompany you to the U.S. or who will come in a different visa status do NOT need to be listed on this form. Name (Last/Family, First) Gender Date of Birth: (MM/DD/YY) Relationship to you (Spouse/Child): City of Birth: Country of Birth: Country of Citizenship: Country of Legal Permanent Residence:

4 THIS SECTION MUST BE COMPLETED BY THE SJSU HOST FACULTY MEMBER Visiting Scholar Family/ Last Name: Visiting Scholar First Name: The purpose of this request is to: A. Begin a new J-1 exchange visitor program at SJSU B. Transfer J-1 exchange visitor from another institution to SJSU* * Exchange Visitor Transfer Eligibility An exchange visitor may transfer from one program sponsor to another if the purpose of the transfer is to complete the objective for which he/she was admitted to exchange visitor status and if the exchange visitor remains within the same participant category (see Section 4 below). Will the Exchange Visitor complete the same program objective he/she is currently pursuing at another institution and remain in the same J-1 category he/she currently holds? YES NO If NO, please contact ISSS for further guidance. Program Extension Note: To request an extension of an on-going J-1 exchange visitor program at SJSU, please use the J-1 Exchange Visitor Extension Request Form. 3. Program Duration What will be the duration of this Exchange Visitor s program at San José State University? Program Start Date (MM/DD/YY) Program End Date (MM/DD/YY) 4. J-1 Exchange Visitor Category In what capacity will this person be serving while at San José State University? Professor: An individual primarily teaching, lecturing, observing, or consulting at post-secondary accredited educational institutions. Research Scholar: An individual primarily conducting research, observing, or consulting in connection with a research project at research institutions, corporate research facilities museums, libraries, post-secondary accredited educational institution. Short-term Scholars: A professor, research scholar, specialist, or a person with similar education or accomplishments coming to the United States on a short-term visit (no longer than 6 months) for the purpose of lecturing, observing, consulting, training, or demonstrating special skills at research institution. Extensions beyond 6 months are not permitted. Specialists: An individual who is an expert in a field of specialized knowledge or skill coming to the United State for observing, consulting, or demonstrating special skills. Student: An individual who will pursue a full course of study leading to or culminating in the award from a post-secondary accredited educational institutions or follow a prescribed course of study with a specific educational objective. Support may not come solely from personal funds

5 5. Program Objective and Subject/Field What specific field(s) of research and/or activities will the Exchange Visitor participate in while at SJSU? Please provide a brief description (1-3 sentences) of the activities the Exchange Visitor will engage in while at SJSU including academic discipline(s) and/or research field(s). The activities must correspond to the J-1 Exchange Visitor Category selected in Section 4. Primary Academic Discipline/ Research Field: Activities: 6. Site of Activity Indicate the physical location of the visiting scholar s activity. Address Primary Site of Activity* Secondary Site of Activity Location Name* (e.g. SJSU, NASA Ames Center) Street Number and Street Name* Suite/Apt # City* State* Zip Code* *Required fields 7. Financial Information What will the Exchange Visitor s exact source and amount of financial support be while at SJSU? The total funds available must be adequate to cover the educational, living, insurance, and personal expenses for the period of time the Exchange Visitor will be at San José State University. Minimum costs for room and board, transportation, and personal expenses are $2,000 per month. Official documentation is required of at least this amount of funding for the length of the visit. Additional funding is required for an accompanying family member ($1,000/ month for the spouse; $500/month for each child). Keep in mind that this is a very conservative amount. The Exchange Visitor should understand the high cost of living in the U.S., in particular in the Silicon Valley area. If funding is provided by SJSU, the invitation letter from the sponsoring department must include detailed financial support information (salary amount, etc.). If funding is NOT provided by SJSU, the visiting scholar must provide official documentation in English specifying the funding amount in U.S. dollars. Funding docs must be issued within past 6 months. Exchange Visitor Student Category Note: A substantial amount of support must come from sources other than Personal Funds.

6 Please list below the total amount of funding for the length of the scholar s visit in each of the categories as applicable. SJSU Salary (Total amount for length of visit)... SJSU Other source (Specify below).... U.S. Government Agency (Specify below).... International Organization (Specify below).... Exchange Visitor s Home Country Government... Other Organization (Specify below)..... Personal Funds (including family funds)... TOTAL Funds... _ SJSU DEPARTMENTAL & COLLEGE APPROVAL Your signature indicates you agree to the SJSU Host Department Responsibilities listed on page 1 of this form. SJSU Host Faculty Member and Department Contact Host Department: Print Name & Title: Phone: SJSU Host Department Contact (if other than above) Print Name & Title: Phone: SJSU Host Department Chair Print Name & Title: SJSU Sponsoring College Dean Print Name & Title: