CHF EXCHANGE TEACHER APPLICATION FORM
Cordell Hull Foundation for International Education – 501 Fifth Avenue, Third Floor, New York, NY 10017
Telephone: 212-300-2138 website: www.cordellhull.org e-mail: CHFNY@aol.com
Complete this application in English or French.
Type or input into computer if available.
Name of School and State where Hired:
PLACE SMALL PHOTO HERE
Last Name First Name Middle Name
Sex: Male ____ Female _____ Date of Birth: Month_____ Day_____ Year______
Place of Birth: City Country
Citizen of: Legal Resident of: (Country)
Address in Home Country:
Address in U.S. (if applicable):
Telephone: Home Work (include country code)
Marital Status: Single _______ Married: _______ Years married: _______ Religion:___________________
Total number of family members to accompany you to the U.S.A. (spouse & children only):
Name of family member Relationship (spouse, Birthdate City of Birth Country of Birth
son or daughter) Mo./Day/Year
NAME (s) of Relative(s) to contact in case of emergency:
Relationship: Phone: email address:
Beginning with university (age 18) until now, please supply the following information:
Institution City, State & Country Name of Degree or Year No. of Semester
Diploma (spell out) Finished Years Hours
Teacher Certifications, Exams or Competitions
List any teaching certifications or other exams you have completed. Spell out the name of the certification and
describe what it certifies you to teach or do in your home country.
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Other hobbies and interests:
Relevant Teaching Experience
Type Sch. Location Inclusive Dates Full-time Student Avg. #
Institution Public or City & Country From To No. or Part- ages students Grades Subjects
Private Date Date Yrs. time / class
Total Years of Teaching Experience:
Other Related Work Experience: Summarize below.
Your native language:
LANGUAGE CHECK WHICH APPLY: LEVEL
Speak Read Write Fair Good Excellent
Have you ever lived OR traveled outside your native country? If yes, please give details.
Country Dates Reason
Please indicate which subjects you can teach: Spanish, French, German, Math, Science or others:
Have you ever been convicted of a crime?
Describe any health problems, chronic illnesses or disabilities that you or any accompanying family member suffer from:
(Write None if none apply)
List the following information for two individuals who can comment on your professional skills, character and
dependability. If possible, provide a 3rd name of a U.S. reference, either personal or professional. Do not list relatives.
Name Address Telephone Position Relation to you
Brief Essay Questions:
How will your participation in our Foreign Language Teacher Associate Program benefit the following:
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2) The Host School
3) The Host Community
In your opinion, what personal characteristics or qualities of yours are important in order to be an
effective and successful Exchange Visitor to the U.S.?
What motivates you to teach in the U.S. and to participate in the CHF Teacher Exchange program?
What is your approach to teaching a foreign language or subject of expertise to groups of 20-30
Do you believe that this cross-cultural experience is important? Through this exchange, how could
you help reduce or eliminate many cultural stereotypes and generalizations held by U.S. citizens
about foreign nationals, and vice versa, after you return to your native country.
Additional items required: (1) One small or passport-size photo.
(2) Copy of certified teaching certificate from your country (or university
degree) (INCLUDE ONE OR THE OTHER – NOT BOTH)
To the best of my knowledge, the information provided is correct. I understand that incorrect
information could be sufficient grounds to invalidate a contract between myself, CHF, and my
employing state or school district.
Approved by: Date:
Marianne Mason, President
THE CORDELL HULL FOUNDATION
for International Education
501 Fifth Avenue, Third Floor New York, NY 10017
Telephone 212-300-2138 Fax: 646-367-4901
Website: www.cordellhull.org email: firstname.lastname@example.org
MEMO OF UNDERSTANDING
BY CHF APPLICANT FOR J-1 VISA EXCHANGE VISITOR SPONSORSHIP
By signing this memo, I attest that I understand that the following conditions are applicable to me as an exchange
1. TWO-YEAR HOME-COUNTRY PHYSICAL PRESENCE REQUIREMENT
Section 212(e) of the Immigration and Nationality Act and PL 94-484, as amended:
Exchange Visitor Teachers who are acquiring a skill which is in short supply in their home country will be subject to the
two-year home-country residence requirement. This means that I am required to reside in my home country for the two
years following completion of my program before I am eligible for immigrant status, temporary worker (H) status or
intracompany transferee (L) status.
2. THREE-YEAR MAXIMUM STAY
I hereby agree not (1) to attempt to stay in the U.S. nor (2) to apply for an H1-B visa after the 3-year period allowed under
Cordell Hull Foundation (CHF) exchange visitor sponsorship. If I wish to return to the U.S. in the future after I complete
the CHF J-1 visa term, I will first remain in my home country for 2 years, as required by No. 1 above.
Exchange visitors are required to have medical insurance in effect for themselves and any accompanying spouse and minor
children on J visas for the duration of their exchange program. At a minimum, my health insurance coverage shall
include: (1) medical benefits of at least U.S. $50,000 per person per accident or illness; (2) repatriation of remains (return
of body in event of death) in the amount of U.S. $7,500; and (3) expenses associated with medical evacuation in the
amount of U.S. $10,000. A policy secured to fulfill the insurance requirements shall not have a deductible that exceeds
U.S. $500 per accident or illness, and must meet other standards specified in the Exchange Visitor Program regulations, 22
CFR Part 62.14.
4. I understand that the above exchange visitor program regulations require that I understand and execute the necessary steps
to obtain J-1 visa approval in my home country. If granted a J-1 visa, I agree to abide by these regulations and all other
regulations governing CHF's J-1 Exchange Visitor Program.
FIRST NAME MIDDLE NAME LAST NAME
Address in home country:
Telephone no. in home country: