Office of International Student & Scholar Services
Brown University
J. Walter Wilson, Suite 510
69 Brown Street, Box 1906 Phone 401-863-2427
Providence, RI 02912 Fax 401-863-7543
Email: oisss@brown.edu www.brown.edu/oisss
Request for Form DS-2019 for J-1 Exchange Visitor
By Brown Affiliated Hospitals
Department/Hospital __________________________ Date _______________
Contact Person _________________________ Email ______________ Phone ________
Mailing Address __________________________________________________________
Purpose of Request: New J-1 ( ), J-1 Extension ( ), Family DS-2019 ( ), Transfer ( )
Visitor's Last Name: __________________ First name___________ Suffix _____ Male ( ) Female ( )
Date of Birth (month, day, year)___________ City & Country of Birth: ______________
Country of Citizenship: ______________ Country of Permanent Residency___________
Position/Occupation in Country of Residence (e.g. graduate student, professor, physician) & Institution
____________________________________________________________
If the Exchange Visitor is currently present in the U.S. please indicate the immigration status_______
Dates of Appointment (Maximum of 5 years for J-1 Status): From________ to ________
Previous time in J-1 Status: From_______ to _______ Institution ___________________
Desired J-1 category: e.g. Short-Term Scholar (6 month maximum), Research Scholar, or Professor
__________________________________ Field of Study__________________________
Source and amount of visitor’s financial support for the period of above:
From or administered by Hospital $______________
Exchange Visitor’s government $____________ Please attach a letter of the grant or a statement.
Other organizations, Name of Organization________________________________
$________________ Please attach a letter of the grant or a statement
Personal funds $__________________________ Please attach a financial statement.
Processing Fee is charged to: Women & Infants Hospital ( ) Butler Hospital ( )
Cost Center# _______________ Authorized by _________________________________
Signature ______________________________ Date _____________________________
Billing Address _________________________________________________________
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The visitor plans bring dependents: No ( ) Yes ( ) If yes, please the following:
Name (Last, Relationship Date of City and Country Country of Country of
First) Birth of Birth Citizenship Permanent
Residence
Where To Send This Request:
For hospital-based faculty or staff, Brown appointment letters from the Dean of Medicine will be
required. All letters should include the visitor's title, inclusive dates of employment, and funding
information. Please send the request form together with the appointment letter to Office of Medical
Faculty Affairs, Box G-A305.
For all Brown University paid Postdoctoral Research Associates in the field of Biology and
Medicine please send the Request for DS-2019 together with the appointment letter to the
Associate Dean for Graduate and Postdoctoral Studies, Box G-A219, Fax: 3-2660.
Office of Medical Faculty Affairs or the Associate Dean for Graduate and Postdoctoral Studies will
forward the DS-2019 request to Office of International Student and Scholar Services after the
appointment letter is signed by the visitor and the visitor returns a copy of the appointment letter to the
OMFA or the Associate Dean for Graduate/Postdoc Studies.
Please allow for a week for The Office of International Student and Scholar Services to generate Form
DS-2019. The form will be mailed to the Department address listed above, unless instructed otherwise.
Documents that must be attached with this request:
1. Copy of the Exchange Visitor’s CV or resume
2. Copy of Exchange Visitor’s passport
Financial Support Guidelines: If applicant is self -supported, please allow $1583/month. If family
members will accompany visitor, please allow $5000 per year for spouse and $3000 per year per child.
Health and accident insurance is mandatory for visitors and accompanying dependents. Further
details about health insurance will be provided to visitors before their arrival in the U.S. (Exchange
Visitors are not required to have insurance until their arrival in the U.S.)
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