J-1 SCHOLAR REQUEST FORM (TO BE COMPLETED BY THE SCHOLAR) Please cmplete this frm and return it t yur hst department as sn as pssible s that we may issue yu a DS-2019, which is used when yu apply fr a J-1 entry visa at a U.S. Cnsulate abrad. Due t delays in visa prcessing verseas, please submit the frm and all required dcumentatin at least three mnths in advance f yur anticipated start date at IIT. Please nte that in sme instances visa prcessing may take lnger. Please read the fllwing infrmatin befre yu cmplete the request frm: Length f Stay: J-1 research schlars and prfessrs are permitted t remain in the United States fr a ttal f five years maximum. Shrt-term schlars are permitted t remain in the United States fr up t six mnths; n extensin is permitted. Repeat Participatin in the Research Schlar and Prfessr Categries: After yu spend time in the U.S. in ne f these categries, yu will be prhibited frm returning t the U.S. fr 24 mnths in either the prfessr r research schlar categry. There are n exceptins t this rule. 12-Mnth Rule: Yu will nt be eligible fr J-1 research schlar r prfessr status if yu were in the U.S. in any J status fr six ut f the previus 12 mnths. In such cases, yu must be ut f J status fr ne year befre yu will be eligible fr J-1 research schlar r prfessr status. English Language Requirement: New federal regulatins beginning January 5, 2015 require use f an bjective measurement f English language prficiency t determine the language prficiency f all J-1 schlars. Yu must submit prf f ne f these measurements with this frm: Results frm a recgnized English language test that meet r exceed the scre belw (preferred methd)»» Accepted English language tests and minimum requirements: TOEFL IBT 57 TOEFL CBT 163 TOEFL PBT 487 IELTS 5.5 PTE 42»» Phtcpies f results mailed directly t the student r screen shts f the nline scre reprt are acceptable. Signed dcumentatin frm an academic institutin r English language schl verifying yu have at least intermediate-level English language skills Or dcumentatin f an interview cnducted by the hst department either in persn, by videcnference, r by telephne if neither f the first tw ptins are viable ptins. NOTE: The Internatinal Center reserves the right t ask fr further verificatin. Tw-Year Hme Residency Requirement: Sme J-1 schlars and their dependents are required t return t their cuntry f permanent residence fr a minimum f tw years upn cmpletin f the J-1 prgram befre they will be eligible fr H, L, K, r permanent residency status. On rare ccasins, the visitr may file fr a waiver f this requirement. Withut the waiver, the J-1 exchange visitr may nt change nn-immigrant status while in the U.S. r apply fr any f the fur statuses listed abve. Once a waiver is received, extensins f J status are nt permitted. J schlars will be subject t the tw-year hme residency requirement if ne f the fllwing cnditins exist: Gvernment funding If yu are being funded in whle r in part directly r indirectly by the U.S. gvernment, yur hme cuntry gvernment, r the gvernment in yur last cuntry f residence Specialized knwledge r skill: skills list If yur cuntry f citizenship r permanent residence has declared yur field f research/study/ wrk necessary t the develpment f yur hme cuntry, as shwn n the Exchange Visitr Skills List (review the Exchange Visitr Skills List 2009, http://travel.state.gv/cntent/visas/english/study-exchange/exchange/exchange-visitr-skills-list.html)
Health Insurance: J-1 participants and their accmpanying dependents are required by law t carry health insurance fr the duratin f the prgram. Yu shuld btain this prir t cming t the U.S. but nt necessarily befre cmpleting this request r applying fr yur entry visa. Optins fr health insurance cverage include: IIT student insurance, if yu will be required t register in research credits IIT emplyee insurance (except fr High Deductible Health Plan), if yu will be paid by IIT Other insurance cmpany, as lng as the plan meets the minimum requirements set frth by the U.S. Department f State (additinal infrmatin will be included with yur DS-2019) Funding: Prf f funding t meet the fllwing expenses fr the duratin f yur stay in the U.S.: Living expenses f $1,400/mnth ($16,800/year) IIT student health insurance fee (www.iit.edu/shwc/insurance), if applicable Cst f tw research credits per term (ne credit/summer term) if required t register Plus living expenses fr any dependents (see Dependents sectin belw) Evidence f funding must be less than six mnths ld and may be ne r mre f the fllwing: Bank statement in yur name Schlarship/grant award letter in yur name indicating the amunt and duratin f supprt Letter frm yur emplyer r academic institutin indicating the amunt and duratin f supprt Bank statements in a spnsr s name, plus a letter f supprt frm the persn named n the statement, indicating the amunt and duratin f supprt If yu are being funded by IIT, the hst department will prvide the Internatinal Center with the apprpriate dcumentatin. Yu will nly be respnsible fr prviding additinal funding dcumentatin if yur financial supprt frm IIT des nt meet r exceed the required minimums. Please nte in cases where a funding range (instead f a specific amunt) is given, nly the lwest amunt in the range can be used when calculating funding ttals. Dependents: Yu may apply t bring yur spuse and children (unmarried and under the age f 21) with yu as J-2 dependents. T d s, yu must shw an additinal $375/mnth ($4,500/year) fr the first dependent and $250/mnth ($3,000/year) per each additinal dependent yu wish t bring t the U.S. Please make sure yu prvide prf f the apprpriate amunt f financial supprt. Please nte that gvernment regulatins require that all J-1s and J-2s prvide a valid email address. If yur dependents d nt have valid email addresses, please list yur wn. Yu may nt leave it blank.
J-1 SCHOLAR REQUEST FORM CHECKLIST Please submit the fllwing t yur hst department: J-1 schlar request frm Prf f English language prficiency Financial dcumentatin (in English and less than six mnths ld) if yur funding is nt frm IIT Cpy f yur passprt bigraphical page (plus that f any dependents) Cmpleted Health Insurance Attestatin Frm Once yur hst department submits the request and all supprting dcumentatin t the Internatinal Center, it may take up t tw weeks t prepare the DS-2019. After we have prepared the DS-2019, yur hst department will mail the DS-2019 frm and ther imprtant infrmatin t yu.
J-1 REQUEST FORM (TO BE COMPLETED BY THE SCHOLAR) Please cmplete the infrmatin belw. ALL fields are required. Family name (as it appears in passprt): First name (as it appears in passprt): Middle name, if applicable: Male Female Date f birth (mm/dd/yyyy): City f birth: Cuntry f birth: Cuntry f legal permanent residence: Permanent address in hme cuntry: Email address: Highest degree btained (chse ne) Bachelr s Master s Dctrate Other (LLM, JD, MD, etc. please specify): Psitin last held in cuntry f citizenship r legal permanent residence: (i.e., graduate student, lawyer, prfessr, research assciate, etc.) Name f university r place f emplyment: Are yu currently in the U.S.? N Yes (please attach dcumentatin f current status, i.e., DS-2019, I-20, I-797, etc.) Have yu been in the U.S. in J-1 r J-2 status in the past 12 mnths? N Yes (please attach dcumentatin shwing hw lng yu were in the U.S.) Have yu entered the U.S. as a J-1 research schlar r J-1 prfessr in the past tw years? N Yes (please attach cpies f yur previus DS-2019s)
Will yu be bringing dependents with yu? N Yes (please cmplete the infrmatin belw and attach cpies f their passprt bigraphical page) DEPENDENT #1 Family name (as it appears in passprt): First name (as it appears in passprt): Middle name, if applicable: Male Female Date f birth (mm/dd/yyyy): City f birth: Cuntry f birth: Cuntry f legal permanent residence: Spuse Child Email address: Dependent des nt have an email address. Please use my email address instead. DEPENDENT #2 Family name (as it appears in passprt): First name (as it appears in passprt): Middle name, if applicable: Male Female Date f birth (mm/dd/yyyy): City f birth: Cuntry f birth: Cuntry f legal permanent residence: Spuse Child Email address: Dependent des nt have an email address. Please use my email address instead. Yu may attach additinal pages, if needed.
J-1 SCHOLAR HEALTH INSURANCE ATTESTATION FORM This frm must be cmpleted, signed, and returned t the Internatinal Center. All J-1 schlars and their dependent(s) are required t have health insurance that meets the minimum requirements as defined by the United States Department f State, which gverns the Exchange Visitr Prgram. J-1s and their dependent(s) may als be subject t the requirements f the Affrdable Care Act. The insurance cverage must prvide the fllwing minimum cverage: Medical benefits f at least $100,000 per persn per accident r illness Repatriatin f remains in the amunt f $25,000 Medical evacuatin expenses in the amunt f $50,000 A deductible that des nt exceed $500 Yu may be eligible fr IIT insurance if yu are required t register r if yu will be paid by IIT. Cntact yur hst department fr mre infrmatin. I understand that while in J-1 status in the U.S., I am required t maintain health insurance with the minimum cverage as specified abve fr myself and any accmpanying dependents. I hereby affirm that I have, r will have by the time I begin my visit at Illinis Institute f Technlgy, the stated insurance fr the entire duratin f my stay in the U.S. I als acknwledge that willful nncmpliance with the insurance prvisins will result in the terminatin f my participatin in the Exchange Visitr Prgram. Signature Date Print name Department Email address