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Section 6: Medical Insurance
All J-1 exchange visitors are required by the U.S. government to have medical insurance which meets the established
for the visitor and J-2 dependents for the full duration of time
the U.S. in the J visa status.
an exchange visitor willfully fails to
maintain this insurance, we are required by U.S. government regulations to terminate the visitor's J program status and report to the
Department of State. FGCU sponsoring departments are expected to assist
the exchange visitor in meeting this requirement. Please refer to
the "Exchange Visitor Insurance Requirement" document for more detailed information.
The exchange visitor's health insurance will be paid for by this department for:
Exchange visitor only Exchange visitor and dependents
By checking the box below, I acknowledge that it is the responsibility of the exchange visitor to secure coverage through an independent
insurance provider OR be covered by contract as a FGCU
I accept and acknowledge these terms.
Section 7: EV Program Limitations and Responsibilities
Please refer to "Exchange Visitor/Scholar Eligibility, Categories, and Related Requirements" and "Instructions for FGCU
Host Foreign National Exchange Visitors" on detailed limitations and responsibilities regarding the
Exchange Visitor program at FGCU. By
checking the box below, the sponsoring unit acknowledges they have read and understood the conditions that apply to the exchange visitors.
I have read and understood these conditions and acknowledge the responsibilities associated with the FGCU Exchange Visitor program.
Section 8: Human Resources Approval – If Scholar will be FGCU employee
FGCU position title of the exchange visitor: _______________________________________________
All appropriate administrative processes have been/are being completed according to FGCU Human Resources
guidelines. (For OPS
positions, the OPS Appointment Form must be completed and submitted to HR. For established, advertised positions the appropriate
Appointment Form must be completed and submitted to HR and the Official Offer
Letter generated and executed.)
FGCU HR representative's signature:
Section 9: Attachments
Please submit the following support documents attached to this request. Mark the box for each item attached.
Resume or Curriculum Vitae (Mandatory)
Previous DS-2019, if applicable
Copy of current visa, if applicable Copy of current I-94, if applicable
Letter of invitation from department or HR
Letter from off-site host, if applicable