College of Engineering J-1 Scholar
All Departments
Today's Date
Department Number
*
Please Select
8H000
8H007
8H060
8H090
8H200
8H300
8H350
8H400
8H600
8H700
8H750
8H755
8H800
Department Administrative contact name:
Department Administrative contact email:
example@example.com
Name of J-1 Scholar
UK ID#
Birthdate:
-
Month
-
Day
Year
Date
HR Official Title
New end Date of DS-2019
-
Month
-
Day
Year
Date
Detailed Reason for Extension
*
Is this person a graduate student in their home country?
Yes
No
If yes, upload visiting student approval form from Grad School.
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Is the Department sponsoring the student?
Yes
No
Enter funding amount for the extension:
Enter Grant #
Will personal funds be used?
Yes
No
Enter funding amount for the extension:
If yes, upload visiting student approval form from Grad School.
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Is the exchange visitor's government providing funding? *****If yes, please confirm that this is foreign government funding. This will automatically trigger the two-year home country rule for this exchange visitor. Please verify that this is NOT a foreign agency.
Yes
No
Enter Amount of Funding from Exchange Visitor's Government for the entire stay:
Upload proof of funding from visitor's government.
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Is a US Government Agency providing funding?
Yes
No
Enter Agency Name:
Enter US Government Agency funding for entire stay:
Will the visiting scholar have funding from another source?
Yes
No
Describe Source:
Enter funding for the entire stay for other source:
Upload proof or other funding.
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Is the exchange visitor on a UK Employee Health Plan?
Yes
No
Upload Proof of Insurance
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Upload Medical Evacuation & Repatriation insurance for extension period.
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JV Account #
Name of Final Approver (Requesting Faculty)
Email of Final Approver
example@example.com
VISA Coordinator
example@example.com
Submit
Should be Empty: