J-1 DS-2019 Request Form for Exchange Visitor Applicant

Transcription

1 J-1 DS-2019 Request Frm fr Exchange Visitr Applicant 1. Persnal Infrmatin (as it appears in yur passprt) Address Gender: Male Female Last psitin/ccupatin yu held in yur cuntry f legal permanent residence *If yu wrte Student abve, were yu an undergraduate r graduate student? Name f cmpany/rganizatin r institutin where yu wrk r study Address in the United States (nly if yu are extending yur current DS-2019): 2. Immigratin Infrmatin Have yu previusly held J-1 visa status in the United States within the past 24 mnths? N Are yu subject t the 212(e) 2-year hme residency requirement? N Lyla University Chicag, ISSS, 6339 N. Sheridan Rad, Sullivan Center, Suite 206, Chicag, IL T: F: E: iss@luc.edu W: luc.edu/iss

2 If yu are subject t the 212(e) 2-year hme residency requirement, have yu received a waiver? (please attach cpies f yur waiver dcument, DOS recmmendatin letter, and I-612) N Are yu currently living in the United States? (answer the questins belw) N (skip t Sectin 3 belw) If yu are currently living in the United States, what is yur current immigratin/visa status? Will yu be applying fr a change f status within the United States (this is nt recmmended due t filing and prcessing times with USCIS befre yu can begin yur prgram at Lyla University Chicag)? N If yu will exit the United States and return befre the start f yur prgram at Lyla University Chicag, please prvide yur departure and re-entry dates belw: Departure (mm/dd/yyyy) Re-Entry (mm/dd/yyyy) 3. Funding All exchange visitr/j-1 visa applicants must prvide prf f funding fr the duratin f their stay in the U.S., currently calculated at a rate f $1250 per mnth ($15,000 per year). Additinal funding fr (J-2 visa) dependents f the EV/J-1 visa applicant are currently calculated at a rate f $460 per mnth fr spuses, and $320 per mnth fr each child. Financial supprt dcuments must have been issued/dated within the past six (6) mnths, and shuld clearly specify the accunt hlder s name and available dllar amunt in the accunt(s). T ensure verificatin f sufficient funding fr yur entire prgram at Lyla University Chicag, cpies f yur funding r schlarship letters, cnfirmatin f salary cntinuatin, and/r persnal r spnsr s bank statements must be included with this request. All dcuments must be translated int English. 4. Health Insurance Cverage Under regulatins f the United States Department f State, all individuals wh enter the U.S. n a J-1 visa are required t have health insurance t cver themselves and any accmpanying dependents fr the duratin f their prgram. This insurance cverage must meet the fllwing requirements fr bth yurself and any accmpanying dependents (if applicable): - Medical benefits f at least $100,000 per accident r illness - Repatriatin f remains in the amunt f $25,000

3 - Expenses assciated with the medical evacuatin f the exchange visitr t his r her hme cuntry in the amunt f $50,000 - A deductible nt t exceed $500 per accident r illness Exchange visitrs may prvide prf f their existing health insurance cverage, althugh insurance purchased abrad (r frm a prvider in the U.S.) must meet the stated requirements abve and be cntinuus fr the duratin f their (and their dependent s) prgram. It is the respnsibility f the exchange visitr t prvide insurance infrmatin and plicy cverage dcumentatin t their hst department. Willful failure t maintain adequate insurance cverage during the exchange visitr s stay in the U.S. in J-1 visa status will result in the terminatin f their prgram. 5. Dependent/Family Member Infrmatin (if applicable) This sectin is nly fr exchange visitrs wh plan t bring dependent family members t the United States with them. Each dependent family member will be issued their wn DS-2019 and will need t btain a J-2 visa. Remember t attach cpies f passprt bigraphical pages fr each dependent. Spuse:

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5 6. Exchange Visitr Cnfirmatin Name Signature Date Required dcumentatin fr all requests: Cpy f passprt bigraphical page (fr exchange visitr and all dependents as applicable) Prf f funding (if nt funded by Lyla University Chicag; this culd be in the frm f dcumentatin frm the rganizatin(s) supprting yu, and/r persnal r spnsr s bank statements; see Sectin 3 abve) Required dcumentatin if transferring frm anther department r U.S. institutin s J-1 prgram: Cpy f current DS-2019 Cpy f J-1 visa stamp r USCIS apprval ntice ***If changing immigratin/visa status t J-1 within the United States, after btaining his r her DS-2019 frm Lyla University Chicag, the exchange visitr must file frm I-539 with USCIS and wait fr USCIS apprval befre beginning their prgram at Lyla University Chicag.*** Once yu have cmpleted this frm and cllected the necessary dcumentatin, submit everything directly t yur hst department cntact persn. Yur hst department cntact persn will submit yur dcumentatin directly t the Office fr Internatinal Prgrams n yur behalf fr DS-2019 issuance.