Please select type of J-1 request:
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INITIAL/NEW J-1 EXCHANGE VISITOR
EXTENSION FOR CURRENT J-1 EXCHANGE VISITOR
Please select the J-1 visa category being requested:
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RESEARCH SCHOLAR: Individual would conduct research, observe, or consult in connection with a research project. Maximum visa duration is for up to 5 years. Must have a minimum of a bachelor's degree to be eligible.
SHORT-TERM SCHOLAR: Professor, research scholar, or person with similar background who would lecture, observe, consult, train, or demonstrate special skills. Maximum visa duration is for up to 6 months. Must have a minimum of a bachelor's degree to be eligible
STUDENT INTERN: Internship experience would fulfill objectives of a current degree program at home institution. Student must be currently enrolled at home institution. Maximum visa duration is for up to 1 year.
PROFESSOR: Individual would teach each, lecture, observe, or consult. Maximum visa duration is up to 5 years. Must have a minimum of a bachelor's degree to be eligible.
Department Name:
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Physical Address:
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If OTHER address is selected, please list it here:
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Last Name:
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First Name:
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Title:
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Phone Number/Extension:
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Email Address:
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Last Name:
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First Name:
* must provide value
Title:
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Phone Number/Extension:
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Email Address:
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Last Name:
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First Name:
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Full Title:
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Last (Family) Name:
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First (Given) Name:
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Email Address:
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Current Place of Residence:
Anticipated Program End Date:
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Today M-D-Y
Address of Exchange Visitor's Site of Activity:
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Anticipated Program Start Date:
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Today M-D-Y
If the site of activity is outside of the main KUMC campus, is the sponsoring supervisor affiliated with the University of Kansas Medical Center?
Yes
No
Recommended Field/Major Best Describing J-1 EV's Activities (i.e. biomedical sciences, microbiology, etc.):
Brief Description of J-1 EV's Activities/Research Focus:
INDICATE THE SOURCE OF FUNDING FOR THE EXCHANGE VISITOR'S (EV) PROGRAM:
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KUMC PAID: Funding will be provided by KUMC, which could include grants. EV will be classified as a KUMC employee, given an HR title, and paid through KUMC Payroll (i.e. Postdoctoral Fellow, Research Associate, etc.).
NON-KUMC Paid J-1 EV - Visiting Scholar/Researcher: Funding is provided from a non-KUMC source such as an international scholarship, grant, personal funds, or a combination of these sources. EV is not considered a KUMC employee, will not have an HR title or be placed on KUMC Payroll. Visiting Scholars/Researchers engage in an exchange, research, or projects that would promote collaborative efforts or contribute to KUMC's projects and research.- Limited to 1-year duration.
NON-KUMC Paid J-1 EV - Individualized Researcher: Fee-based program that allows the Individualized Researcher to gain more experience in performing research techniques or obtain exposure to a research lab. Sponsoring supervisor at KUMC and Researcher would custom tailor an individualized research program to help accomplish the researcher's goals and objectives. Funding and fees are provided by the Researcher. Limited to 1-year duration.
NON-KUMC Paid J-1 EV - Student Intern: Funding is provided from a non-KUMC source such as an international scholarship, grant, personal funds, or a combination of these sources. Intern is not considered a KUMC employee, will not have an HR title or be placed on KUMC Payroll. Interns engage in research outlined on the DS-7002 training plan completed by the KUMC hosting department. Limited to 1-year duration.
Position Title:
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Please attach a copy of the position description
Please attach a copy of the position description if J-1 previously was not in paid position
Please attach a copy of the offer letter:
Please attach a copy of the offer letter if J-1 previously was not in a paid position:
Please note, the annual salary amount for the position title must meet HR requirements. Please contact your HR Business Partner for more details.
Annual Salary Amount (USD):
* must provide value
Please list the sources of funding for this position:
Include details about grants and related details
RESEARCH PLAN:
Please upload the completed Research Plan here:
When requesting for the J-1 student intern category, we are required to also issue a form called a DS-7002 in addition to the DS-2019. Please download this fillable PDF copy and complete as much of it as possible. We will then issue the SEVIS generated form to append with the DS-2019.
Please attach DS-7002 form completed and signed by program supervisor:*please note that OIP will obtain signature from incoming student intern once the form has been reviewed*
* must provide value
Please attach a Letter of Support:
Please provide an explanation and reasons for seeking an extension beyond the one-year on a J-1 status for the non-KUMC paid EV:
* must provide value
Please note the following for non-KUMC paid requests.
Non-KUMC Paid EVs must provide proof of funding that meets these minimum requirements:J-1: $39,276 for 12 months , or $3,273 per month J-2: $5,000 for 12 months (for each J-2 dependent), or $416.67 per month Non-KUMC paid J-1s cannot be classified under HR titles. These individuals will be assigned separate titles such as Visiting Researcher, Research Scholar, Visiting Professor, or Visiting Lecturer. Sponsoring departments have the option to supplement the prospective EV's funding. However, this amount can only be paid in a form of an award and the EV will not be placed on payroll. Please note, Accounts Payable or the Research Institute must approve and create a Glacier record prior to the issuance of an award.An award is an amount of money a KUMC department pledges toward the support of a non-KUMC paid Exchange Visitor to help with expenses or to offset expenses incurred by the EV while being hosted by the department. In some instances where funding is provided by the EV's home employer or university a general exchange agreement may be required. OIP will contact the EV directly if an agreement is required. Non-KUMC paid EVs are limited to a one-year experience. Exceptions must be reviewed and approved by OIP, the Vice Chancellor for Academic and Student Affairs, and the Vice Chancellor for Research. Proof of funding must not be older than six months from the time of the request.Proof of funding documents must be copies of originals or certified copies, printed on official letterhead or equivalent. If the document is not in English, a certified translation must be attached to the original copy. OIP will request proof of funding documents directly from the J-1 Exchange Visitor.
Will the department supplement the EV's funding with an award?
Yes
No
Total award amount (USD): * must provide value
Source of award (i.e., grant, etc.): * must provide value
Please not that you will need to work with either Accounts Payable or the Research Institute to process and issue this award.
Please note the following for non-KUMC paid positions:
The Researcher will be responsible for providing proof of funding for the following minimum cost of living expenses: J-1: $39,276 for 12 months , or $3,273 per month J-2: $5,000 for 12 months (for each J-2 dependent), or $416.67 per month The minimum proof of funding amounts listed above are required for J-1 sponsorship at KUMC and the issuance of the DS-2019 document for the prospective Researcher. OIP will facilitate the process in obtaining proof of funding directly from the prospective Researcher. The Researcher will be responsible for also paying the following Individualized Researcher Program fees: $500 per month program fee paid to the Office of International Programs (OIP) $500 per month paid to the sponsoring department The department reserves the right to waive the sponsoring department fees. Program fees must be paid prior to the start of the program. Please indicate whether the sponsoring department selects to:
* must provide value
Waive the department fee for the International Individualized Researcher Program, in doing so the Researcher is responsible for only covering the OIP fee.
Confirm the department fee will apply for the International Individualized Researcher Experience. This department fee is in addition to the OIP fee that the Researcher is responsible for paying prior to the start of the experience. *The Researcher will pay the department fee directly to the department prior to the start of the program.
If the department would prefer to charge a different fee amount for the program, please indicate the fee amount that should apply.
* must provide value
(Please specify if amount is to be paid per month or per week)
In some cases, an exchange visitor who is an "alien physician" or foreign trained physician participating in "a program of observation, consultation, teaching or research may need to have limited patient contact in order to carry out those objectives. If the patient contact is incidental to those objectives, a physician participating in a non-clinical exchange program can engage in incidental patient contact." However, Incidental Patient Contact must be approved by the Office of International Programs' Responsible Officer, Sponsoring Department Supervisor, Sponsoring Department Chair, Vice Chancellor for Academic and Student Affairs, and Executive Dean of School of Medicine. If there is reason to believe that incidental patient contact may occur with a prospective exchange visitor physician, please contact the Office of International Programs directly.
Is the J-1 Exchange Visitor a foreign trained physician?
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Yes
No
Will there be incidental patient contact?
* must provide value
Yes
No
If "yes" is selected: Please note that OIP must obtain a signed "Certificate to Supplement form DS-2019". OIP will be in contact with further instructions upon receipt of this completed request form.
The U.S. Department of State designated the University of Kansas Medical Center to sponsor foreign nationals for the purpose of engaging in scholarly activity including research, teaching, consultation, and observation. The U.S. Department of State regulations strictly prohibits KUMC from sponsoring individuals who will be participating in patient care or clinical activity.
Will the employee work in an area where animal research experiments are conducted?
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Yes
No
What animals will the employee be working around?
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What type of biological hazards
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What type of biological hazards
If applicable, what type of clinical interaction will this position encounter?
Export Control Laws: What is a Deemed Export?
Export control laws are designed to prevent the export of unlicensed sensitive equipment, software, and technology to ensure U.S. national security and foreign policy objectives. Export control is regulated by multiple U.S. agencies. These laws can result in severe fines and prosecution. This liability applies to KUMC and you as a private citizen.
Export of sensitive equipment, software, or technology can occur when it is:
Available to foreign nationals for visual inspection (such as reading technical specifications, plans, blueprints, etc.) Exchanged orally Made available by practice or application under the guidance of persons with knowledge
The Deemed Export Questionnaire is aimed at determining whether an export license will be required before releasing controlled technology to a foreign person.
Please note: information or research data shared within the scientific community or to the public is generally exempt from export control laws under the
Fundamental Research clause. Nonetheless, the completion and review of the deemed export questionnaire is still required.
For more information on Export Control Laws, please visit the KU Office of Export Controls at
https://export-compliance.ku.edu/ Please provide a list of any scientific equipment, including highly specialized computing equipment that the exchange visitor will use in the course of performing his/her duties.
* must provide value
Will the exchange visitor have access to information regarding how to install, maintain, repair, refurbish and overhaul a particular piece of equipment?
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Yes
No
Will the exchange visitor be exposed to equipment that was specifically designed or developed for military or outer space applications?
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Yes
No
Will the exchange visitor work on projects or collaborations that will be then shared within the scientific community or to the public (fundamental research clause)?
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Yes
No
Will the research projects involve export controlled technology and or materials including infectious or hazardous agents?
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Yes
No
For research funded solely by the University, does the University intend to withhold the research results for proprietary reasons and not share broadly in the scientific community?
* must provide value
Yes
No
Per the Department of State regulations, J-1 Exchange Visitors are required to participate in cultural exchange activities while on program in the United States. KUMC further requires that J-1 Exchange Visitors attend at least one cultural exchange event or activity per month. Please note that J-1 Exchange Visitors should be expected to provide proof or more information about their activities at OIP's follow-up appointments or at the time of the J-1 extension process.
The Office of International Programs offers several opportunities throughout the year for J-1 participants to attend cultural exchange events, this includes but is not limited to the following:http://www.kumc.edu/office-of-international-programs/events-and-programming/community-conversations.html http://www.kumc.edu/international-programs/programs-and-events/clinical-culture-and-diversity-series.html http://www.kumc.edu/international-programs/programs-and-events/international-education-week.html http://www.isikansascity.org/ http://www.kumc.edu/international-programs/events-calendar.html
By signing, the sponsoring department acknowledges that the prospective J-1 Exchange Visitor will need to attend cultural exchange events.
* must provide value
Please provide a description on the types of cultural exchange activities the J-1 will engage in duration the program.
Please download the "Department Statement of Responsibility Agreement and Acknowledgement" form.
Please download the "Department Statement of Responsibility Agreement and Acknowledgement" form.
Once completed and signed, please upload the "Department Statement of Responsibility Agreement and Acknowledgement" form using the link below:
* must provide value
Processing fee paid to the Office of International Programs (paid by the sponsoring department/laboratory):
FEE TYPE: APPLICABLE FEE AMOUNT: OIP J-1 Processing Fee $550
Processing fee paid to the Office of International Programs (paid by the sponsoring department/laboratory):
FEE TYPE: APPLICABLE FEE AMOUNT: OIP J-1 Processing Fee $550
Processing fee paid to the Office of International Programs (paid by the sponsoring department/laboratory):
FEE TYPE: APPLICABLE FEE AMOUNT: OIP J-1 Processing Fee $300
Processing fee paid to the Office of International Programs (paid by the sponsoring department/laboratory):
FEE TYPE: APPLICABLE FEE AMOUNT: OIP J-1 Processing Fee $550
The OIP Processing Fee can be paid by check made payable to KUMC-Office of International Programs or as an IDB transfer.
The OIP Processing Fee can be paid by check made payable to KUMC-Office of International Programs or as an Internal Service Delivery (ISD).
FD
Cost Center # (must be a 4 digit code only or we can't process an ISD)
CC
NACUBO
GR
Please upload the completed IDB transfer form here:
Please upload the completed DS-7002 form here:
* must provide value
Submit
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