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J-1 Visa Intake FormInternational Scholars OperationsThis form is provided to facilitate collection of information for the J Visa Request Form. Academic units must submit a J Visa Request Form to initiate visa sponsorship through ISO. Please contact ISO with questions.Employee ID (if any): FORMTEXT ?????PART I: To be completed by the international scholar being invited to the University of Washington (UW).Section One - Biographic InformationEnter names as they appear on the passportFull Name: FORMTEXT Scholar family name/surname, FORMTEXT Scholar primary name/given name (Please refer to the Machine Readable Zone of your passport. Do not use any dashes (“-“), slashes (“/”, “\”), or special characters.) Date of Birth: FORMTEXT MM/DD/YYYYGender: FORMCHECKBOX Female FORMCHECKBOX Male City of Birth: FORMTEXT City/town of birthCountry of Birth: Choose an item.Passport country/Primary country of citizenship: Choose an item.Additional country of citizenship: Choose an item.Additional country of citizenship: Choose an item.Country of legal permanent residence if different than country of citizenship: Choose an item.E-mail address: FORMTEXT username@domain.eduAre you currently in the U.S? FORMCHECKBOX YES FORMCHECKBOX NOIf YES, list U.S. address: FORMTEXT Address line 1 FORMTEXT Address line 2 FORMTEXT Address line 3 FORMTEXT Address line 4If YES, list current nonimmigrant status: FORMTEXT Nonimmigrant statusWhen did you last arrive in the U.S.? FORMTEXT MM/DD/YYYYWhen will your current status expire? FORMTEXT MM/DD/YYYYHave you received, or are you in the process of applying for, a waiver of the 212(e) two-year home residence requirement?* FORMCHECKBOX YES FORMCHECKBOX NO If YES, provide more detail regarding the home residence waiver application and where you are in the process: FORMTEXT Provide more detail about your waiver application. * Please note that if you receive a positive recommendation from the Department of State on your waiver application, we are no longer able to extend your J-1 status.Select one of the following if you have made any prior visits to the U.S.: FORMDROPDOWN For each prior visit to the U.S. (except as a B-1 or B-2 or visa waiver), list your nonimmigrant status and dates of stay: FORMTEXT Enter nonimmigrant status and dates of stay (MM/DD/YYYY - MM/DD/YYYY)Home Country Position:Select one position from the Home Country Position Description for International Scholars list that follows the end of Part I. Type or copy and paste that position into the box below. Your entry MUST be a position description from the list: FORMTEXT Enter your home country position (from the list below) Home Country Job Title: FORMTEXT Enter your official titleHome Country Employer: FORMTEXT Enter the official nameAre you a graduate of a non-U.S. medical school? FORMCHECKBOX YES FORMCHECKBOX NOHighest Degree Earned: FORMTEXT Enter the official degreeField of Study: FORMTEXT Enter the official field nameName of Granting Institution: FORMTEXT Enter the official nameDate Received: FORMTEXT MM/DD/YYYY Are you enrolled or pursuing a degree at an academic institution outside of the U.S.? FORMCHECKBOX YES FORMCHECKBOX NOIf YES:Name of institution where you are enrolled or pursuing a degree: FORMTEXT Enter the official nameWhat is your current degree level (bachelor’s, master’s, Ph.D., M.D., etc.)? FORMTEXT Enter the official degreeAnticipated Degree Completion Date: FORMTEXT MM/DD/YYYYEnglish Proficiency RequirementEvery exchange visitor must possess sufficient proficiency in English to successfully participate in the program and function on a day-to-day basis. Federal law requires sponsors to use and retain evidence of one of the following "objective measurements" to determine the scholar's English language proficiency. See for more information.I can provide the following documentation of my English language proficiency: FORMCHECKBOX A recognized English language test FORMCHECKBOX Signed documentation from an academic institution or English language school FORMCHECKBOX A documented interview conducted by the sponsor either in-person or by videoconferencing, or by telephone if videoconferencing is not a viable option.Section Two - DependentsDependents include your spouse and children under age 21.List dependents only if they are coming to the U.S. or are currently in U.S. in J-2 status.Do not list dependents who hold U.S. passports or dependents who were born in the U.S. Enter names and dates exactly as they appear in passports.If you have more than four dependents, list them on a separate page.Dependent One:Relationship: FORMCHECKBOX Spouse FORMCHECKBOX ChildFull Name: FORMTEXT Family name/surname, FORMTEXT Primary name/given name Date of Birth: FORMTEXT MM/DD/YYYYGender: FORMCHECKBOX Male FORMCHECKBOX FemaleCity of Birth: FORMTEXT City/town of birthCountry of Birth: Choose an item.Passport country/Primary country of citizenship: Choose an item.Additional country of citizenship: Choose an item.Additional country of citizenship: Choose an item. Country of legal permanent residence if different than country of citizenship: Choose an item.Dependent Two:Relationship: FORMCHECKBOX Spouse FORMCHECKBOX ChildFull Name: FORMTEXT Family name/surname, FORMTEXT Primary name/given name Date of Birth: FORMTEXT MM/DD/YYYYGender: FORMCHECKBOX Male FORMCHECKBOX FemaleCity of Birth: FORMTEXT City/town of birthCountry of Birth: Choose an item.Passport country/Primary country of citizenship: Choose an item.Additional country of citizenship: Choose an item.Additional country of citizenship: Choose an item.Country of legal permanent residence if different than country of citizenship: Choose an item.Dependent Three:Relationship: FORMCHECKBOX Spouse FORMCHECKBOX ChildFull Name: FORMTEXT Family name/surname, FORMTEXT Primary name/given name Date of Birth: FORMTEXT MM/DD/YYYYGender: FORMCHECKBOX Male FORMCHECKBOX FemaleCity of Birth: FORMTEXT City/town of birthCountry of Birth: Choose an item.Passport country/Primary country of citizenship: Choose an item.Additional country of citizenship: Choose an item.Additional country of citizenship: Choose an item.Country of legal permanent residence if different than country of citizenship: Choose an item.Dependent Four:Relationship: FORMCHECKBOX Spouse FORMCHECKBOX ChildFull Name: FORMTEXT Family name/surname, FORMTEXT Primary name/given name Date of Birth: FORMTEXT MM/DD/YYYYGender: FORMCHECKBOX Male FORMCHECKBOX FemaleCity of Birth: FORMTEXT City/town of birthCountry of Birth: Choose an item.Passport country/Primary country of citizenship: Choose an item.Additional country of citizenship: Choose an item.Additional country of citizenship: Choose an item.Country of legal permanent residence if different than country of citizenship: Choose an item.Dependent Five:Relationship: FORMCHECKBOX Spouse FORMCHECKBOX ChildFull Name: FORMTEXT Family name/surname, FORMTEXT Primary name/given name Date of Birth: FORMTEXT MM/DD/YYYYGender: FORMCHECKBOX Male FORMCHECKBOX FemaleCity of Birth: FORMTEXT City/town of birthCountry of Birth: Choose an item.Passport country/Primary country of citizenship: Choose an item.Additional country of citizenship: Choose an item.Additional country of citizenship: Choose an item.Country of legal permanent residence if different than country of citizenship: Choose an item.lefttopHome Country Position Description for International Scholars (Page 1 of 2)020000Home Country Position Description for International Scholars (Page 1 of 2)ACADEMIC COMMUNITYUniversity level positions:University president or rectorUniversity administrative staffUniversity teaching staff including researchersUniversity graduate studentsUniversity undergraduate studentsUniversity medical studentsUniversity students in other professionsUniversity post grad medical traineeUniversity, other positionsSecondary School positions:Secondary school principalSecondary school teacher or staffSecondary school studentSecondary school, other positionsElementary school positions:Elementary principal, teacher or staffElementary school, other positionsSpecial schools, institutes or vocational school positions:Special school, institute or vocational headSpecial school, institute or vocational teacher or staffSpecial school, institute or vocational, other positionsAGRICULTURE (including forestry and fisheries):Agricultural entrepreneurExecutive of agriculture businessAgricultural managerEmployee of agricultural enterpriseProfessionals or scientists in agricultureAgriculture, other positionsARTSArtist (graphic arts)Author (playwright, poet)Stage or film actorFilm or stage producerComposer or musicianArts, other positionsCOMMUNICATIONSElectronic media positions:Head of TV or radio stationRadio or TV journalistElectronic media technicianElectronic media, other positionsPrinted media positions:Editor and/or publisherJournalistTechnical official in printed media fieldPrinted media, other positionsFilm as news media positions:Film makerFilm as news media, other positionsGOVERNMENTCentral government positions:Head of governmentMinisterial level officialExecutive level officialCivil service employee in central governmentProfessionals and scientists in central governmentLegislator in central governmentJudges in central governmentManager of state enterpriseCentral government, other positionsState, regional or provincial government positions:Governor or other chief of regional unitSenior head of regional departmentExecutive level regional officialsCivil service employee in regional/state governmentProfessionals and scientists in regional governmentLegislator in regional or state governmentJudges in regional or state governmentManager of regional enterpriseRegional government, other positionsCity or town government positions:Mayor or city managerHead of city departmentExecutive level city or town officialCivil service employee in city or town governmentProfessionals and scientists in city or town governmentLegislator in city or town governmentJudges in city or town governmentManager of city enterpriseCity or town government, other positionsIMPORTANT POLITICAL FIGURES NOT CLASSIFIED ELSEWHEREOpposition leader (not in government)Opposition leader, legislatureFormer influential political officialImportant political figureINTERNATIONAL ORGANIZATIONHead of international organizationSenior official of international organizationEmployee of international organizationlefttopHome Country Position Description for International Scholars (Page 2 of 2)020000Home Country Position Description for International Scholars (Page 2 of 2)LABORLabor union positions:Labor union headLabor union officialLabor union other positionsLabor union ministry positions:Labor ministerSenior ministerial officialMinistry of labor, other positionsLabor experts in academia positions:Labor experts in academia positionsLabor organization and other labor positions:Head of labor organizationEmployee of labor organizationMILITARYMilitary positionsPRIVATE SECTORPrivate business positions:Private business entrepreneurCorporate executiveManager employed by private businessEmployee of private businessProfessional or scientist in private businessPrivate business, other positionsSelf-employed professionals positions:Legal fieldMedical fieldTechnical fieldSelf-employed, other positionsIndependent, non-profit, hospitals or other organization positions:Director of institute/corporation or hospitalManager/executive employed by institute/corporationEmployee of independent institute or corporationInstitute/corporation professional na./scien (?)Independent, non-profit, hospitals or similar organization, other positionsRELIGIONMinister of religionReligious order/congregation memberTheologianSPORTSAthleteCoachSports, other positionsPART II: To be completed by the UW academic unit that is inviting the international scholar.Section Three – Appointment InformationUW Appointment Title: FORMDROPDOWN Proposed Dates of J-1 Sponsorship: DS-2019 forms are normally issued to match the duration of the appointment; please see for more information. FORMTEXT MM/DD/YYYY to FORMTEXT MM/DD/YYYYInternational Scholar’s UW Activities (check as many as applicable): FORMCHECKBOX Research FORMCHECKBOX Observation FORMCHECKBOX Teaching FORMCHECKBOX Consultation with colleagues FORMCHECKBOX Demonstrating special skills FORMCHECKBOX Other. If “Other,” please specify: FORMTEXT Enter your responseList all activity locations, including the UW campus building name and room numbers for on-campus activity locations and street address and zip codes for off-campus activity locations. If there are more than four locations, include a separate attachment. FORMTEXT Activity address FORMTEXT Activity address FORMTEXT Activity address FORMTEXT Activity addressWill the scholar also perform work from the current US address listed above in Section One*? FORMCHECKBOX YES FORMCHECKBOX NOField of Specialization at the UW: FORMTEXT Enter the official field nameInternational Scholar’s UW Faculty Supervisor: FORMTEXT First and last nameTitle of Faculty Supervisor: FORMDROPDOWN Is Exchange Visitor enrolled in or pursuing a degree at an academic institution outside US?? To sponsor a foreign student for supervised research-based learning at UW, DO NOT submit a visa request to ISO; instead, contact the VISIT Program.What plans are in place for the scholar and the scholar’s dependents to participate in American cultural activities? Please see our ?J-1 Cultural Exchange Requirement? page. FORMTEXT Enter your responseSection Four - Funding InformationSee for information on funding requirements for J-1 exchange visitors. OAP recommends obtaining documentation of all funding before submitting the visa request; you must provide documentation of funding with the complete visa request packet after conditional approval by OAP.UW Appointment Service Period: FORMCHECKBOX 9-month FORMCHECKBOX 12-monthThis refers to the school/college/campus and position service period, not the sponsorship period.UW Per-Month Salary: Include only salary paid through UW payroll for the proposed dates of sponsorship. Monthly full-time salary does not include pay through PDR, clinical or practice plan revenue, or incentive payments. DO NOT round off amount: $ FORMTEXT XX,XXX.XXTotal UW salary for the requested sponsorship period: $ FORMTEXT XX,XXX.XXUW non-salary compensation for the full sponsorship period: $ FORMTEXT XX,XXX.XXUW non-salary compensation type: FORMTEXT Enter your responseNon-UW funding amount for the full sponsorship period: $ FORMTEXT XX,XXX.XXConverted to US $ if in foreign currencyNon-UW funding sources: FORMTEXT Enter your responsePersonal funds for the full sponsorship period: $ FORMTEXT XX,XXX.XXConverted to US $ if in foreign currencySection Five - Sponsoring Department/Program InformationUW Academic Home Department/Program: FORMTEXT Enter the official nameUW Academic Home School/College/Campus: FORMTEXT Enter the official nameUW Unit Contact Details (for further information regarding this visa request):Contact Name: FORMTEXT Enter the official nameContact’s Email: FORMTEXT UW NetID@uw.eduSecondary Contact Name: FORMTEXT Enter the official nameSecondary Contact Email: FORMTEXT UW NetID@uw.eduTertiary Contact Name: FORMTEXT Enter the official nameTertiary Contact Email: FORMTEXT UW NetID@uw.eduNetIDs who should be able to view this visa request: FORMTEXT Enter your responseList any other NetIDs for other people in your unit who should be able to access this visa request and associated files. DO NOT list the scholar’s NetID.Campus Box: FORMTEXT 35XXXXCampus Phone: FORMTEXT 5-5555UW Unit Budget Details (for processing fee):Budget Name: FORMTEXT Enter the official nameBudget Number: FORMTEXT XX-XXXXBudget Option/Project/Task: FORMTEXT XX-XX-XXBudget Contact Name: FORMTEXT First and last nameBudget Contact’s Email: FORMTEXT UW NetID@uw.eduDepartment Chair/Program Director Name: FORMTEXT First and last nameDean’s/Chancellor’s Name: FORMTEXT First and last nameDean’s/Chancellor’s Office Contact’s Name: FORMTEXT First and last nameDean’s/Chancellor’s Office Contact’s Email: FORMTEXT UW NetID@uw.eduAdditional InformationUse this space to add comments or information: FORMTEXT Enter your response ................
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