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: Conduct research, observing, or consulting in connection with a research project. Maximum visa duration is up to 5 years. Must have a minimum of a bachelor's degree.
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 up to 6 months. Must have a minimum of a bachelor's degree.
STUDENT INTERN: Internship experience would fulfill objectives of current degree program in home institution. Student must be currently enrolled at home institution. Maximum visa duration is 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.
Please select the classification of your position at KUMC:
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KUMC PAID: Funding will be provided by KUMC. EV will be classified as a KUMC employee, given a university HR classified title, and paid through KUMC Payroll (i.e. Postdoctoral Fellow, Research Associate, etc.).
NON-KUMC Paid J-1 EV - Visiting Scholar/Individualized Researcher: Funding is provided from a non-KUMC source such as an international scholarship, grant, personal funds, etc. EV is not considered a KUMC employee, will not have an HR title or be placed on KUMC Payroll. Visiting Scholars engage in an exchange, research, or projects that would promote collaborative efforts. Individualized Research engage in research for their own individual benefit. Programs are limited to a 1-year experience.
Family Name:
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Given Name:
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Male
Female
Date of Birth:
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Today M-D-Y MM/DD/YYYY
Social Security Number (if applicable):
City of Birth:
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Province/State of Birth:
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Country of Birth:
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Country of Citizenship:
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Country of Permanent Residency:
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Email Address:
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CURRENT ADDRESS (where you live; cannot be place of employment):
Address (street name and number):
PERMANENT ADDRESS (complete if different from the current address):
Address (street name and number):
CURRENT EMPLOYMENT INFORMATION:
Most Recent Position Held in Home Country:
Name of Last Employer in Home Country:
Location of Last Employer in Home Country:
All Degree Certificates Earned:(https://www.trustfortecorp.com/) , FCSA (http://foreigncredentials.org/) or another U.S. evaluation service provider
Have you obtained a Bachelor's Degree?
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Yes
No
Have you obtained a Master's Degree?
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Yes
No
Have you obtained a Doctoral Degree (e.g., PhD, EdD)?
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Yes
No
DEGREE TYPE: Doctoral (e.g., Ph.D., Ed.D.):
Have you obtained a Professional Degree (e.g., MD, MBBS, JD, DVM)?
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Yes
No
Please upload copies of degree certificates.(If your degree certificates are not in English, please upload certified English translations):
Bachelor's Degree Certificate:
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Master's Degree Certificate:
Doctoral Degree Certificate:
Professional Degree Certificate:
1) Have you ever held F-1/F-2 status?
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Yes
No
Please attach copies of status documents:
2) Have you ever held J-1/J-2 status?
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Yes
No
Please attach copies of status documents:
3) Have you ever held any other visa status in the United States not listed in questions 1 and 2?
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Yes
No
Please attach copies of status documents:
I am a J-1 exchange visitor. A department at the University of Kansas Medical Center has requested to extend my J-1 Exchange Visitor status. As documented on my DS-2019 and/or J-1 Visa Stamp;
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I am not subject to Section 212(e), the 2-year home country physical presence requirement.
I am subject to Section 212(e), the 2-year home country physical presence requirement.
If subject to Section 212(e), I understand that I am ineligible for an extension of my J-1 status once I have made application for a waiver of Section 212(e) and the U.S. Department of State has issued a letter of "no objection"; I may fulfill the terms of my current program only. Furthermore, the Responsible Officer (RO) or Alternate Responsible Officer (ARO) in accordance with the regulations is unable to issue an extension of the DS-2019 in this situation. I have,
not made an application for waiver of Section 212(e).
submitted an application for waiver of Section 212(e), but have not received a letter or "no objection" from the DOS.
received a letter of "no objection" from the U.S. Department of State (DOS) and am waiting for a response from the USCIS
been granted a waiver to Section 212(e) by the USCIS
applied for and been denied a waiver by the DOS or the USCIS.
You selected that you received a letter of "no objection" from the U.S. Department of State (DOS) and are waiting for a response from the USCIS.
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Please attach a copy of the Notice of Action (Section 212(e) by the USCIS):
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Please select the appropriate item about health insurance coverage: I have,
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Please provide the following supporting documents:
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- Attach printout of the benefits screen from HR/Payroll System:
Proof of Medical Evacuation and Repatriation coverage:(Please be sure that proof includes coverage start and expiration dates as well as minimum allowed expenses)
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Please provide the following supporting documents:
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- Attach brochure/confirmation that outlines minimum amounts for general coverage (accident/illness medical benefits, maximum co-insurance, maximum deductible):
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Proof of Medical Evacuation and Repatriation coverage:(Please be sure that proof includes coverage start and expiration dates as well as minimum allowed expenses)
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Position title:
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Annual Salary Amount (USD):
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As a non-KUMC paid EV, you must provide proof of funding that meets the following 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 These minimum requirements are based on university cost of living estimates. The minimum proof of funding amounts are required for J-1 sponsorship at KUMC and the issuance of the DS-2019 document. As a non-KUMC paid EV, you must provide proof of funding that meets the following 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 These minimum requirements are based on university cost of living estimates. The minimum proof of funding amounts are required for J-1 sponsorship at KUMC and the issuance of the DS-2019 document. General requirements: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 included. Proof of funding cannot be older than 6 months from the date of completing this questionnaire. Requirements based on type of funding:International scholarship, home government grant, or other organization award:Provide copies of official notification of scholarship, grant, or related funding issuance Proof of funding should indicate amount and duration of support Home country employer or university support:Provide copies of official notification of employer or university support Proof of funding should indicate amount and duration of support Signed General Agreement for Cultural, Education, and Research Cooperation may be required Personal funds:A recent bank statement or letter from bank (in English or a certified translation) that shows available funds for the proposed exchange visit. Please make sure the type of currency is clearly indicated. Please indicate anticipated title:
Total Funding Amount (USD):
Duration of Funding (in months):
Please list sources of your funding (i.e., type, source, funding country of origin):
Will your employer or university provide funding for the duration of the J-1 program?
Yes
No
(If yes, please note that OIP may need to obtain a signed general agreement with your employer or university).
Please upload your proof of funding documents here:
* must provide value
WHAT IS J-2 VISA?
A J-2 is a visa type for dependents of a J-1 Exchange Visitor.
J-2 dependents can only be the spouse and/or child/children of the J-1 exchange visitor. Children over the age of 21 are not eligible for J-2 status.
In order for DS-2019 documents to be issued for your J-2 dependents, the J-1 Exchange Visitor must show that he or she will have sufficient funds to support all dependents. Please reference the following minimum funding 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 Accompany the J-1 Exchange Visitor to the United States while the J-1 pursues his or her program objectives. J-2 dependents can study and obtain work authorization (EAD card) while in the United States. J-2 dependents' visa status is valid as long as the J-1 Exchange Visitor is maintaining status. J-2 dependents must carry health insurance coverage at all times while the J-1 Exchange Visitor's program is active even when the J-2 dependent is outside the United States. Do you have dependent family members (spouse/children) who will need J-2 status?
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Yes
No
Do you have dependent family members (spouse/children) who will need J-2 extensions?
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Yes
No
Please list J-2 dependents who will require extensions:
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MINIMUM FUNDING REQUIREMENTS:
In order for DS-2019 documents to be issued for your J-2 dependents, the J-1 Exchange Visitor must show that he or she will have sufficient funds to support all dependents. Please reference the following minimum funding 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
* must provide value
Upload proof of health insurance coverage for all J-2 dependents:
* must provide value
Male
Female
Spouse
Child
Today M-D-Y
Is the dependent currently in the United States?
Yes
No
Has the dependent ever held J-1 or J-2 status?
* must provide value
Yes
No
Please indicate dates each status held:
* must provide value
Will the dependent remain in the United States for the entire duration of the J-1's program?
* must provide value
Yes
No
Please provide more information:
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Please upload a scanned copy of the dependent's passport identification page:
* must provide value
Please upload a scanned copy of the dependent's proof of relationship to J-1 Exchange Visitor:
* must provide value
i.e. Marriage Certificate, Birth Certificate
Will you have an additional dependent?
* must provide value
Yes
No
Family Name:
* must provide value
Given Name:
* must provide value
Gender:
* must provide value
Male
Female
Relationship to J-1 EV:
* must provide value
Spouse
Child
Today M-D-Y
Country of Birth:
* must provide value
City of Birth:
* must provide value
Country of Citizenship:
* must provide value
Is the dependent currently in the United States?
* must provide value
Yes
No
Has the dependent ever held J-1 or J-2 status?
* must provide value
Yes
No
Please indicate dates each status held:
Will the dependent remain in the United States for the entire duration of the J-1's program?
* must provide value
Yes
No
Please provide more information:
Please upload a scanned copy of the dependent's passport identification page:
* must provide value
Please upload a scanned copy of the dependent's proof of relationship to J-1 Exhange Visitor:
* must provide value
i.e. Marriage Certificate, Birth Certificate
Will you have an additional dependent?
* must provide value
Yes
No
Family Name:
* must provide value
Given Name:
* must provide value
Gender:
* must provide value
Male
Female
Relationship to J-1 EV:
* must provide value
Spouse
Child
Date of Birth:
* must provide value
Today M-D-Y
Country of Birth:
* must provide value
City of Birth:
* must provide value
Country of Citizenship:
* must provide value
Is the dependent currently in the United States?
* must provide value
Yes
No
Has the dependent ever held J-1 or J-2 status?
* must provide value
Yes
No
Please indicate dates each status held:
* must provide value
Will the dependent remain in the United States for the entire duration of the J-1's program?
* must provide value
Yes
No
Please provide more information:
* must provide value
Please upload a scanned copy of the dependent's passport identification page:
* must provide value
Please upload a scanned copy of the dependent's proof of relationship to J-1 Exchange Visitor:
* must provide value
i.e. Marriage Certificate, Birth Certificate
Will you have an additional dependent?
* must provide value
Yes
No
Family Name:
* must provide value
Given Name:
* must provide value
Gender:
* must provide value
Male
Female
Relationship to J-1 EV:
* must provide value
Spouse
Child
Date of Birth:
* must provide value
Today M-D-Y
Country of Birth:
* must provide value
City of Birth:
* must provide value
Country of Citizenship:
* must provide value
Is the dependent currently in the United States?
* must provide value
Yes
No
Has the dependent ever held J-1 or J-2 status?
* must provide value
Yes
No
Please indicate dates each status held:
* must provide value
Will the dependent remain in the United States for the entire duration of the J-1's program?
* must provide value
Yes
No
Please provide more information:
* must provide value
Please upload a scanned copy of the dependent's passport identification page:
* must provide value
Please upload a scanned copy of the dependent's proof of relationship to J-1 Exchange Visitor:
* must provide value
i.e. Marriage Certificate, Birth Certificate
The U.S. Department of State Subpart A regulations require that "The exchange visitor possesses sufficient proficiency in the English language, as determined by an objective measurement of English language proficiency, successfully to participate in his or her program and to function on a day-to-day basis." [22 CFR 62.11(a)(2)] Effective January 1, 2015, an incoming Exchange Visitor is responsible for providing documented proof of English proficiency that meets the regulations in [22 CFR 62.11(a)(2)].
A RECOGNIZED ENGLISH LANGUAGE TEST: TOEFL IELTS Cambridge English Language Assessment * Minimum test scores have to meet intermediate levels.
** If teaching or lecturing is involved, language test results should meet the University of Kansas Medical Center's TOEFL and IELTS minimum requirements. Please visit OIP's website for more information on the minimum requirements at http://www.kumc.edu/international-programs/academic-english-requirements.html
DOCUMENTATION FROM AN ENGLISH LANGUAGE SCHOOL.
ENGLISH PROFICIENCY INTERVIEW WITH ENGLISH3. The Office of International Programs partners with English3, a company that facilitates an English proficiency digital interview that is evaluated within 5 business days. The interview is available for purchase ($99 USD). Please contact an OIP adviser for more details. QUALIFY FOR A WAIVER:
Waiver is based on one of the following reasons: Incoming exchange visitor provides documented proof that he or she previously earned a degree from a U.S. college or university. Attained degree from an institution where the language of instruction was English. Submit a signed letter attesting that English is the language of instruction from a dean or other university representative. Please select the type of English Proficiency proof you are providing:
* must provide value
Please upload your English Language test here:
If you would like to start the English3 interview, purchase the interview through the following URL:
https://english3.com/studentCheckoutChoose.php?buy=KUMCJ1
The English3 Interview costs $99 USD. The interview should be comprised of 10 questions and the module will provide additional instructions on how to take the video interview. Your interview will be evaluated and you will receive a response within 5 business days. Although English3 will issue the evaluation, our office will also review your results. Upon successful completion of the interview, you will receive a verification letter. J-1 Exchange Visitors may be required to show proof of certain types of immunizations upon arrival and starting the J-1 Exchange Visitor Program at the University of Kansas Medical Center (KUMC). The Department of Environment, Health, and Safety will review your lab or sponsoring department's requirements and will issue a list of immunizations you will need to obtain. The Office of International Programs will forward these immunizations requirements to you during the DS-2019 request process.
(Please note that you may be responsible for covering the costs of any immunizations you plan to obtain upon arrival).
If your previous Internship Approval Form does not cover the period of the requested extension, an updated form will be needed to process the request.
Please download the Internship Approval Form.
Once completed and signed, please upload the Internship Approval Form here:
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Please upload a copy of your passport identification page:
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Please upload a copy of your CV/Resume:
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Do you have any additional items to upload?
* must provide value
Yes
No
As an Exchange Visitor, I attest that the information provided in this form is true and correct. In addition, I have read, understood, and agree to the following terms when on the J-1 program at the University of Kansas Medical Center:
Notify the Office of International Programs of arrival in Kansas City and attend check-in/validation appointment as well as the J-1 Orientation program.The check-in/validation should occur no later than 3 days after arriving in Kansas City. If check-in does not occur within 30 days before or after the program start date indicated on the DS-2019, the exchange visitor's record will become invalid and out of status regardless of the J-1 visa stamp validity. Provide the following documents and information at check-in/validation appointment:Passport, DS-2019, U.S. Visa Stamp, I-94, Physical Address in the United States, Contact Information, Emergency Contact Information, and Proof of Health Insurance that meets U.S. Department of State requirements Ensure the compliance with the U.S. Department of State health insurance requirements as specified at 22 C.F.R. - 62.14.Medical benefits of at least $100,000 per accident or illness; Repatriation of remains in the amount of $25,000; Expenses associated with medical evacuation of the exchange visitor to his or her home country in the amount of $50,000; A deductible not to exceed $500 per accident or illness; and Maximum co-insurance of 25% Provide accurate program, funding, and other related information throughout the duration of the J-1's program at KUMC. This includes:Cancellation of EV's program Intent to transfer to another KUMC department or sponsor Termination or early completion of program Significant changes in position/project Changes in funding sources and amounts Plans to change status Attend classes Participate in cultural exchange activities to ensure compliance with Department of State's requirements. This includes:Attending one cultural exchange event every month. "Ensure that the activity in which the exchange visitor is engaged is consistent with the category and activity listed on the exchange visitor's Form DS-2019." [62.10(e)(1)]. This means that the EV should maintain his or her original program objectives as indicated on the initial DS-2019 request and form. J-1s whether classified as KUMC paid or Non-KUMC paid have the same access to benefits and rights as any other employee. This includes but is not limited to:Attendance and overtime policiesExchange visitors should be aware of typical hours of operation within their department and/or lab. Full-time employment is generally considered working 60 to 100 hours per pay period (every two weeks).Hours worked should not exceed more than 50 hours per week. Non-KUMC paid exchange visitors should track hours worked in a timesheet that is signed off by the sponsoring supervisor per pay period. Office of International Programs should be notified of exchange visitor's absenteeism.If there has been no contact with the exchange visitor for at least 24 hours, the Office of International Programs should be notified immediately. If there has been contact with the exchange visitor, but he or she has been absent for five days with no valid reason, the Office of International Programs should be contacted. Vacation and other type of leave policiesExchange visitors should be aware of vacation and other types of leave available such as vacation, sick leave, family or medical leave, and funeral or death leave. Exchange visitors accrue leave hours in accordance with HR policies. Safe and clean working conditions Receive the necessary training to perform job functions Receive KUMC badge Have KUMC network access and email Be aware of harassment policies Be aware of sexual harassment policies Inclusion in meetings, seminars, and other department activities Retaliation and threat of retaliation policies will not be tolerated Provide sufficient funds to support each dependent if applicable. Will not engage in any patient care or patient contact.Understand that incidental patient contact can occur only if a "Certificate to Supplement DS-2019, Incidental Patient Contact" form is appended to the DS-2019 document. KUMC privacy practices on how personal information is collected, stored, and used is available at the following links:
Click here for the "GDPR Privacy Notice". Click here for the "KUMC Privacy Statement". I attest that the information provided in this questionnaire is true and correct. I have reviewed and understood KUMC privacy practices.
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Today M-D-Y
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