J1 Student Form B _2_ by keralaguest


									                                                              International Student & Scholar Services
                                                                  175 University Avenue, Conklin Hall, Room 216
                                                                                      Newark, New Jersey 07102
                                                                         973-353-1427 (ph) ~ 973-353-5577 (fax)
                                                                                           www. oiss.rutgers.edu

            Exchange/Visiting Student J1 Visa Sponsorship Application
                      (Form B - To Be Completed by Student)

(Please TYPE and email as a Word document to your Rutgers Hosting Department contact person and copy on
OISS at oiss@andromeda.rutgers.edu . OISS will copy and paste your personal info from this form to avoid any typo
when issuing your DS-2019 Certificate of Eligibility for Exchange Visitor (J-1) Status.)

LAST/FAMILY Name                  _________________________________________________________
                                  (Exactly as in passport. Any discrepancy between names on passport
                                  and Form DS-2019 may delay visa process.)

First/Given Name

Middle/Maiden Name

Date of Birth                     ___________/______/______________
                                       (Month/ Day / Year)

Gender                                     □ Male               □ Female

City/Town of Birth

Country of Birth

Country of Citizenship

Country of Legal
Permanent Residence

Email Address:

U.S. Social Security              _________/________/__________
Number:                           You would not have a SS Number if you have never been to the U.S. If
                                  you did get one, the same number is valid for life.

Academic Field to study or        ________________________________________________________
research at Rutgers               This info is needed to match the SEVIS dropdown menu for major fields of study
                                  or research to issue DS-2019. Examples: Management, Finance, Information
                                  Technology, E-Commerce, Neurobiology and Neurophysiology, Biochemistry etc.
Name and Country of
Home School

Academic Degree & Major                       /
at Home School                         Degree / Major

Graduation (or Anticipated
graduation) Date from
Home School

Home Country Permanent            Street Address:
Updated: 12/06/10


                                    Country:                            Post Code:

Start Date of Study or              ___________/______/__________
Research at Rutgers                        (Month/ Day / Year)
                                    Please allow minimum eight weeks between today and your arrival date

End Date of Study or                      ________/______/___________
Research at Rutgers                         (Month/ Day / Year)
                                    You may stay in U.S. up to 30 days after this date.

FAMILY INFORMATION :                Marital Status:        □ Single          □ Married

If married, will spouse and/or children accompany you?                  □ Yes □ No

Or will he/she/they join you at a later date?         □ Yes □ No             If yes, when?

    If family member(s) (spouse and children only) will accompany you or join you at a later date as
    dependent(s) on your visa status, please complete the following section for each family member. If
    you have more than four family members, please attach separate sheet.

   Passport Name          Date Of       City and Country       Country of        Country of Legal       Relationship
 (Family/First/Middle)     Birth             of Birth          Citizenship         Permanent           To J1 Student


Have you ever held J-1 status in the U.S. in the past? Yes                        No

If yes, please enclose photocopies of ALL previous Forms DS-2019 and J1 visas

Are you presently in the United States?               □ Yes             □ No

If yes, please check one:   □ B-1/B-2       □ F-1      □ J-1/J2       □ H-1B       □ Other (specify)
(Please enclose copies of your passport, visa document, and both sides of your I-94 card.)

If yes, will you travel abroad and re-enter the U.S. before beginning your J1 program at Rutgers?

□ Yes □ No If yes, at which U.S. Embassy or Consulate do you intend to apply for your J1 visa to
enter/reenter the U.S.? (specify city & country)

Updated: 12/06/10

 All J-1 Exchange Visitors are required by law to carry health insurance for themselves and accompanying
 family members in J-2 status. Rutgers University requires its international students and scholars to carry
 minimum Health Insurance Coverage as follows:
      Medical benefits of at least $250,000 per accident or illness
      Repatriation of remains benefits in the amount of $7,500
      Medical evacuation benefits in the amount of $10,000
      A deductible that does not exceed $500 per accident or illness
      A coinsurance no greater than 26% of the covered benefits per accident or illness
 Except for students to be registered in classes while at Rutgers who will be charged automatically on tuition bill,
 DS-2019 cannot be issued without proof of health insurance coverage. J1 students may purchase health
 insurance policy through Rutgers University or purchase their own. Non-US policies must be in English.

                       FOR CERTAIN J-1/J-2 EXCHANGE VISITORS

 Some J-1 Exchange Visitors may be affected by a provision referred to as the "two-year home country physical
 presence requirement." This means that after completing his/her program in the U.S. as outlined on the Form
 DS-2019, an Exchange Visitor must return to his/her home country for a period of two years. This requirement
 usually applies to the following: 1) Exchange Visitors whose programs are financed in whole or part, directly or
 indirectly, by the U.S. or home country government or a foreign sponsor; 2) Exchange Visitors whose country
 and field of specialized knowledge (skills) are listed in the most recent "skills list" published by the U.S.
 Department of State; 3) Exchange Visitors who are receiving graduate medical education or training in the U.S.
 A waiver of this requirement may be possible. This special characteristic of J-1/J-2 status should be clearly
 understood by the J1 Exchange Visitor. Any questions regarding this matter should be discussed with the
 Office of International Student and Scholar Service.

CHECKLIST of Documents Required for DS-2019:
     1. Copy of the bio-page of your and your dependents’ passports showing legal name, date of birth,
        city of birth, country of birth, gender and expiration date
     2. Home school written approval for your participation in the J1 program at Rutgers-Newark.
     3. Your very brief study/research plan (less than half page)
     4. Proof (in English) of health insurance coverage for full period of DS-2019 if not purchased
        through Rutgers
     5. Proof of non-personal funding in English if not funded by Rutgers
     6. Original personal or family financial document if your expenses at Rutgers are paid 20% or less
        by personal funding, OR you are on an exchange agreement with Rutgers that requires you to
        pay for your own living expenses. (Note, if the financial document is not in your own name, the
        person whose name appears on the document must write a letter to state relationship with you
        and clarify the fund presented is for you to participate in the J1 program at Rutgers-Newark.)
     7. Copies of previous DS-2019s for J1/J2 status issued by Rutgers and/or any other U.S. institutions
        (if you were in J1 status previously)
     8. Funding for dependents if coming: please provide original financial documents of $5,000/year for
        spouse plus $3,500 for each child) $ _________
     9. Copy of marriage certificate in ENGLISH (must be an official legal translation)

I attest that I have read the information above and fully understand its contents.

Name of Student

Country where this form is filled                                                  Date

Updated: 12/06/10

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