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Application For Extension Of Stay

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					                                            J-1 Student Extension of Stay
An approved extension of stay allows more time for you to study at Iowa State University (beyond the
end date on your current DS-2019 form). The objective stated on your DS-2019 is not changed, only the
length of time in which to achieve the objective. You must complete the entire extension process before
your current DS-2019 expires.

You are eligible for an extension of stay if you meet all the following conditions:
      • Maintain your J-1 student status, including being in good academic standing
      • Carry health insurance for yourself and any J-2 dependents
      • Receive approval from your academic adviser/major professor (exchange students must have
         approval from their ISU exchange coordinator)
      • Provide financial guarantees for the living and academic costs associated with extending your
         stay. You must show proof of sufficient funding for yourself and all J-2 dependents. See an
         International Student Adviser (ISA) for the most recent ISU tuition, fees, and living expenses.

Apply for extension of stay by following these steps:

         1. Complete Section A of the Student (J-1) Extension/Replacement Request form. Attach J-2
            dependent information, if applicable.

         2. Have your academic department complete Section B. Your department may use the
            contingency clause if funding is expected but not yet guaranteed.

         3. Attach financial guarantees, as described in the eligibility conditions above (Letter of Intent,
            bank statement, letter of support from parent or sponsor).

         4. Call 294-1120 to make an appointment with an adviser.
            Bring to this meeting:
            a) Extension of Stay form with Sections A and B completed
            b) Your passport with most current visa and I-94 card
            c) Your current DS-2019(s).

         5. Pick up your new DS-2019 at International Students and Scholars (ISS) when you receive an
            e-mail stating it is ready to pick up and sign it at the bottom of page 1. The DS-2019 is not
            valid until you sign it. Keep all your DS-2019 forms together, as they are the record of your
            legal stay in the U.S.

If you have any questions, please contact an ISA at 294-1120.




H:\Handouts\J-1 Student Extension of Stay.doc
4-9-09
                                      Student (J-1) Extension/Replacement Request

Section A—To be Completed by Student                                                        Date _____________________________________
               (See reverse for dependent information.)                                                         mm/dd/yy

1.   Name ______________________________________________________________      E-mail ___________________________________
            (Family)               (First)      (Middle)
2.   S.S.# ______________________________________ Telephone (Home) ____________________ (Office) _________________________

3.   Current DS-2019 covers period from _______________________________________ to _________________________________________
                                                                 mm/dd/yy                         mm/dd/yy
4.   Request extension until __________________________________________________
                                 mm/dd/yy
     (DS-2019 may be issued for the period of time for which funds are guaranteed or contingent.)

5.   If your funds come from a source other than ISU, list the source(s) and amount(s) from each. You must show funds for the duration of the
     period for which the extension is requested.

     _____________________________________________________               __________________________________________________
     (source)                                                                (amount per month)

     _____________________________________________________               __________________________________________________
     (source)                                                                (amount per month)

                                                                         __________________________________________________
                                                                             (signature of student)


Section B—To be Completed by Department                                        Section C—To be Completed by International Student
                                                                               Adviser
1.   What is the student’s current educational objective and projected
     graduation/completion date?                                               PURPOSE:
                                                                               1. New Program _________________________________
     ___________________________________________
        Degree Sought                                                          2.    Extension ____________________________________

     ___________________________________________                               3.    Transfer _____________________________________
       Graduation/Completion Date
                                                                               4.    Replace lost form/Amend________________
2.   Funds provided by ISU:
                                                                               5.    Reinstatement _________________________________
     _______________________ __________________
      (amount/month)         (from/to dates)                                   TRAVEL: Student     Dependents    Both

      _______________________ __________________                               DATES: From _________________ to ________________
     (amount/month)          (from/to dates)                                                mm/dd/yy              mm/dd/yy

                                                                               FINANCES:
a.   Funds are/are not (please circle) guaranteed through program                Amount __________________ Source ______________
     completion date/graduation.
                                                                                    Amount __________________ Source ______________
b.   ISU support is/is not (please circle) contingent upon academic
     progress and availability of funds.                                            Amount __________________ Source ______________


I hereby endorse the continuation of the above-named individual’s              ______________________________ __________________
educational program at Iowa State University.                                   (Int’l Student/Scholar Adviser) (Date)

_____________________________________ _________                                COMMENTS:
(Major Professor/Program Coordinator) (Date)

____________________________________ __________
  (Department Head)                  (Date)                                             Date Requested: _________________________



H:\Handouts\J-1 Student Extension of Stay.doc
4-9-09
Complete this section only if your family is in the United States in J-2 status. Please type or print clearly.

Family (Last) Name:
Given (First) Name:
*Date of Birth:
City of Birth:
Country of Birth:
Country of Citizenship:
Country of Legal Permanent Residence:
Relationship to Exchange Visitor:
(Husband, Wife, Son, Daughter)

                                                                      *Month of birth must be written out. For
                                                                      example: January
Family (Last) Name:
Given (First) Name:
*Date of Birth:
City of Birth
Country of Birth:
Country of Citizenship:
Country of Legal Permanent Residence:
Relationship to Exchange Visitor:
(Husband, Wife, Son, Daughter)


Family (Last) Name:
Given (First) Name:
*Date of Birth:
City of Birth
Country of Birth:
Country of Citizenship:
Country of Legal Permanent Residence:
Relationship to Exchange Visitor:
(Husband, Wife, Son, Daughter)


I understand that J-1 exchange visitors are required to have health and accident insurance that meets
standards specified by the U.S. Department of State, and that all of my dependents holding J-2 status must
also be covered by health and accident insurance meeting those same standards. Therefore, I will purchase
and maintain the required insurance for myself and all J-2 dependents throughout my stay at Iowa State
University.

________________________________________                               ________________________________________
 Signature                                                              Date

				
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