Employer Interest Form

Employer Interest Form
Full name*

First NameLast Name
Position / Title*
Your position at the business
Business name*
Business type*
For example: restaurant, hotel, theme park, architecture firm, etc.
Business Website*
Business address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone number*

Country CodeArea CodePhone Number
E-mail*
What program are you interested In? (check all that apply)*

Summer Work and Travel ProgramIntern ProgramTrainee ProgramCamp Counselor
Have you worked with the J1 program before?*
Which programs have you worked with before? (check all that apply)*

Summer Work and Travel ProgramIntern ProgramTrainee ProgramCamp Counselor
What season are you interested in hosting participants?*
What size program (number of Exchange Visitors) are you interested in?*
Do you offer housing assistance?*

YesNo
Additional comments
Should be Empty: