2200 S. Josephine St. Denver, CO 80208
Phone:303-871-4912 Email: firstname.lastname@example.org
☐ Enrollment checked by ________
☐ GA processed ____ /____ /____
☐ ISA processed ____ /____ /____
J-1 ON-CAMPUS EMPLOYMENT
Section A: Student Information
Instructions for J-1 students sponsored by DU who wish to work on-campus:
1. Ask your on-campus employer to complete Section B. The employer signature must be an original signature.
2. Submit this form to International Student and Scholar Services (ISSS). If approved, an ISSS advisor will sign Section C.
You should keep this signed form for your records as proof of on-campus employment authorization.
If approved by ISSS the employment authorization will be valid for the dates below (for one year or until the
your DS-2019, whichever is earlier). You may work a maximum of 20 hours/week while classes are in
session and more
than 20 hours/week during vacation periods. You must obtain a new authorization prior to the
expiration date below to
continue working and re-apply if you change jobs.
I hereby authorize the release of any information necessary and authorize any changes needed to complete my request.
ISSS will send all communications about this request to your @du.edu email. Remember to check this account regularly.
SECTION B: To be completed by On-Campus Employer
Name of On-Campus Employer:
Number of Hours per Week?
Employment Start Date:
Employment End Date:
SECTION C: To be completed by ISSS Advisor
Per 22CFR 62.23(g), the Responsible Officer or Alternate Responsible Officer of Exchange Visitor Program P-1-00069
permission for this student to work on-campus in the position above for a maximum of 20 hours per week when
in session and more than 20 hours/week during vacation periods. The student must maintain valid J-1 student
status at DU
to maintain the validity of this authorization. The employment authorization is granted for the dates below.
Start Date of On-Campus Employment Authorization:
End Date of On-Campus Employment Authorization: