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J 1 Visa Extension

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J 1 Visa Extension Powered By Docstoc
					REQUEST FOR EXCHANGE VISITOR PROGRAM (J-1 VISA STATUS) EXTENSION

Name:                                                                              Date of Birth:

PART A (Complete if program extension is required)
Extension requested to:                                          (date)
(Funding must be available for period requested)

Name all source(s) of funding, including supplement/stipend               Amount per year (US$)
                                                                                   $
                                                                                   $

Is either source of funding (listed above) a U.S. or foreign government agency?        Yes       No
    ♦ NIH funds awarded to the laboratory director are considered institutional funds, not government agency funds

    For additional information regarding NIH funds for post-doctoral fellows or students, contact the OSP Department.

How will funds be disbursed?         Scripps payroll check or stipend fellowship             Direct Pay to exchange visitor **
** Note: If the funds will be disbursed through Direct Pay to the exchange visitor, then proof of the exchange visitor’s Direct Pay
must be submitted with this extension request.

Foreign Address (including postal code) _______________________________________________________________
                                           _______________________________________________________________
U.S. Address (including postal code) __________________________________________________________________
                                        __________________________________________________________________
ATTACH A COPY OF BOTH FRONT AND REVERSE SIDES OF THE EXCHANGE VISITOR’S I-94 CARD
(INCLUDING ALL DEPENDENT’S, IF APPLICABLE)


PART B (Complete if program extension is NOT required)

Termination date:

                     Forwarding Address:               _________________________________________________________
                                                       _________________________________________________________




                                          _______________________________________
                                              Signature of TSRI Principal Investigator


Type or Print Name of TSRI Principal Investigator                         Extension                              Mail Drop


                                              Please sign either PART A or PART B
                    Return Extension Form and/or supporting documentation to the International Office – TPC18

				
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posted:7/25/2009
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