J-1 Summer Work & Travel Program Registration Form
Instructions: Before you start this application, ensure to the have the required documents listed on the J-1 Summer Work and Travel Program website.
Personal Details
Name
*
First Name
Last Name
Gender
*
Female
Male
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Country Residence
Birth City:
*
Birth Country:
*
Resident of:
*
Citizen of:
*
Program Eligibility
I am a full-time student at an accredited university or other state recognized institution of post-secondary education. The degree/diploma course on which you are registered must be at least 2 years in duration. You must have completed at least one semester of study. Students on post-graduate courses which are less than two years can also be accepted (e.g. masters courses). "Gap year" students or high school graduates are not eligible. I am also between the ages of 18-28 years old.
*
Yes I agree
College/University/Employer:
*
College/University/Employer's Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
College/University/Employer's Phone:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Year of Study: (Students must enter):
-
Month
-
Day
Year
Date
Graduation Date (Students must enter):
-
Month
-
Day
Year
Date
Major (Students must enter):
Are you taking at least 12 credits this semester? (Students must enter):
Yes
No
SWT Availability Date
*
-
Month
-
Day
Year
Date
Emergency Contact
Name
*
First Name
Last Name
Relationship
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Health History
Do you have an illness that may impair your ability to work?
*
Are you taking any medications?
*
Yes
No
If yes, state:
Are you Covid-19 vaccinated?
*
Yes
No
If yes, state the manufacturer:
Travel History
Do you have travel History within the past 5 years?
*
Yes
No
Do you have a US Visa?
*
Yes
No
Visa Control Number
Visa issue date:
-
Month
-
Day
Year
Date
Visa expiry date:
-
Month
-
Day
Year
Date
Have you ever been denied a visa?
*
Yes
No
If yes, please state why?
Have you ever been denied entry, or your visa revoked?
*
Yes
No
Have you ever been arrested or have anycases before the court?
*
Yes
No
J-1 Program History
Have you participated in any Bridge USA Program?
*
Yes
No
Which program?
*
For example: Summer Work and Travel
Document Upload
Program Fee Deposit Receipt
*
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Digital Passport Photo
*
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Passport Bio Page
*
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CV/Resume
*
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Proof of Status School Status
*
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Signed Agency J-1 Summer Work and Travel Program Terms and Conditions
*
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Signature
*
Submit
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