205 Bradley Hall
Lexington, KY 40506-0058
J-1 Student Intern Verification
Complete the following form by checking the correct box and signing your name. This must be submitted to the
sponsoring department of the University of Kentucky before your application process can begin.
Yes/True No/False Qualification Criteria
I am currently enrolled full-time in my chosen career field at a degree or certificate-
granting post‐secondary academic institution outside the US or graduated from such an
institution no more than 12 months prior to the beginning date of my internship
program at the University of Kentucky.
I have a sufficient grasp of the English language to function on a day to day basis.
(Confirmation of language ability will be confirmed by department/sponsor via
recognized language test, video conferencing or telephone interview.)
This internship program will be in the field of my academic study. My dean or academic
advisor will write a letter of support which confirms this.
If I will be on the University of Kentucky payroll, my dean or academic advisor must give
approval and will include this in the letter of support.
I can show that I have sufficient funds to support myself for the duration of my stay,
through employment in the U.S., support from my home institution or personal funds.
(The University of Kentucky requires evidence of at least $1,500/month per month.)
I have a passport valid for six months after the date of my intended entry to the United
The primary objective of my trip is to engage in a full‐time internship of at least 32 hours
per week. If I wish to take a class at UK it is limited to a maximum of 6 undergraduate
credits during a regular term and 3 undergraduate credits during a summer term. I will
be responsible for enrolling as a non‐degree seeking student.
The maximum duration of my internship is 12 months, and I am expected to depart the
U.S. with 30 days of the completion of my program.
I must have health insurance that meets the requirements set by the University of
Kentucky when I arrive in the US, or agree to purchase such insurance through the
University upon arrival. I have read and understand the attached information about
HEALTH INSURANCE FOR J-1 VISA HOLDERS
Health Insurance Requirement
The U. S. Department of State requires all J-1 Exchange Visitors and their J-2 dependents to carry health,
repatriation and medical evacuation insurance with a reputable company during the period of time they are
participating in the Exchange Visitor program.
Exchange Visitors do not have to buy insurance prior to arrival at the University of Kentucky; however, they
should have funds available to purchase it for themselves and their dependents after their arrival on campus. J-1
Scholar/Student Interns will be eligible to participate in the insurance plan offered to all University of Kentucky
international students, Humana Student Health Insurance. The fees are listed below.
Government regulations stipulate that if Exchange Visitors do not comply with the insurance requirements for
themselves and/or their dependents, the University must terminate the program and report the termination to
the Bureau of Educational and Consular Affairs in Washington.
Required Insurance Specifications
The University of Kentucky has minimum benefits for the type and amounts of coverage for all international
scholars. These exceed those of the U.S. Exchange Visitor Program. The policy must be payable in the U.S. and
the insurance company must have an A.M. Best financial rating of at least “A.” The requirements are as follows:
80% of covered medical expenses paid by insurance
Medical benefits - $200,000 per accident or illness
Maximum deductible of $500 per accident or illness
Outpatient surgery - $10,000
Coverage of Pregnancy
Repatriation of remains - $7,500
Medical evacuation to home country - $10,000
*IF ANOTHER POLICY OR PLAN IS CHOSEN, IT MUST MEET THE ABOVE REQUIREMENTS*
Annual Insurance Costs
J-1 Scholar/Intern/Student - $1,064 per year
J-2 Spouse - $2,868 per year
J-2 One child - $2,264 per year
Two or more children (no additional charge for more than two children) - $4,258 per year
For further information regarding cost, please see: www.ahpcare.com/uky.
Below is a breakdown of costs per period. Keep in mind that you must have insurance to cover your entire stay in the U.S.,
so if your visit overlaps two or more periods of insurance coverage, you must buy the entire block of insurance. You may
want to consider this when planning your internship dates.
st nd rd th th
Annual 1 Period 2 Period 3 Period 4 Period 5 Period
8/26/10- 8/26/10- 10/29/10- 1/1/11- 3/26/11- 6/11/11-
8/26/11 10/29/10 1/01/11 3/26/11 6/11/11 08/26/11
Student $1162 $203 $203 $272 $242 $242
Spouse $3133 $548 $548 $733 $652 $652
One Child $2473 $433 $433 $579 $514 $514
2+ Children $4651 $815 $815 $1087 $967 $967