J1 Visa

Authorization Code*

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J1 Visa
Name*

First NameLast Name
Name of Camp*
Position at Camp*
Type of Visa*

Camp CounselorSummer Work Travel
Camp Contract*

Upload a File
Please attach a copy of your SIGNED camp contract. Cancelof
Contract Start Date*

MonthDayYear
Contract End Date*

MonthDayYear
Occupation*
Is this your first J-1 Visa?*

YesNo
If no, how many J-1 Visas have you had?
Please indicate the year, the visa category, and the sponsoring organization. For example, 2 - Camp Counselor - CCUSA
Applicant Information

It is important that you enter this information as it appears on your passport.
Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*

MaleFemale
City of Birth*
Please enter the unabbreviated City in which you were born.
Country of Birth*
Please enter the unabbreviated Country in which you were born.
Citizenship*
Please enter the unabbreviated Country in which you maintain Citizenship.
Country of Legal Residence*
Please enter the unabbreviated country in which you are a legal permanent residence.
Passport Number*
Please supply us with your full passport number.
Issuing Country*
Please enter the name of country which issues your passport.
Copy of Passport*

Upload a File
Please attach a copy of the BIOGRAPHICAL page of your passport for verification. Cancelof
University Information
Name of School
Field of Study
Year in School
Graduation Date

MonthDayYear
Will you be a full-time student next year?

YesNo
Proof of Student Status

Upload a File
If you are applying for a Summer Work Travel Visa, you must be a full-time student. Please attach written proof of your student status. College ID card is not acceptable. Cancelof
Contact Information
Present Address - This is the address you want your paperwork sent to. Must be able to receive FedEx.*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Permanent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Country CodeArea CodePhone Number
E-mail*
Emergency Contact Information
Emergency Contact Name*

First NameLast Name
Relationship*
Emergency Contact Phone Number*

Country CodeArea CodePhone Number
Emergency Contact E-mail*
Applicant Agreement

I have read and agree to the Terms and Conditions (http://www.greatcampjobs.com/j1visa_terms.htm) outlined by CampGroup, LLC. As part of the agreement, I will be enrolled in the medical insurance program. I know of no reason why I would be refused a visa from the U.S. Embassy or the U.S. Department of State. I attest that all information provided on this application is true and I understand that providing false or misleading information will result in the cancellation of my program.
Do you agree with the above statement?*

YesNo

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J1 Visa

Applicant Information

University Information

Contact Information

Emergency Contact Information

Applicant Agreement