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J1 Vsapply (University of Dayton)

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Visiting Scholar Application Form
International Student and Scholar Services
300 College Park, Rike Center #204
Dayton, OH 45469-1701
Ph: (937) 229-2748 • Fax: (937) 229-2766
1
Last update: Dec 2018
In partnership with Human Resources and the Office of the Provost, ISSS has established a formal procedure for
all arrangements to sponsor and host international visiting scholars. The information collected through this form is
necessary for administrative and immigration purposes and therefore should be submitted whether or not a visa is
required.
To ensure that your Visiting Scholar has everything they need to arrive on schedule, this form should be
submitted by the UD faculty sponsor (host) at least two months prior to the proposed appointment start date.
PART A: REQUIRED DOCUMENTATION
The Visiting Scholar Application Form should be submitted along with the following documents:
Copies of Visiting Scholar and dependent’s (if any) passports
Copy of Visiting Scholar’s CV (English)
Copy of financial documentation (English)
Evidence of English proficiency (if not conducting interview)
Original, signed invitation letter
If submitting by campus mail, please refer to the address information on this form’s header.
If submitting items electronically, please email to isss@udayton.edu.
PART B: VISITING SCHOLAR INFORMATION
Visiting Scholar
Family name
First name
Gender Male Female
Date of birth (mm/dd/yyyy)
City of birth
Country of birth
Country of residence
Job title in home country
Address
City
State/Province
Country
Postal Code
Phone number
Email address
Emergency Contact:
Name ___________________________________
Relationship ______________________________
Phone number _________________________
Is the Visiting Scholar a US citizen or Permanent Resident (Green Card holder)?
Yes (if yes, this form is not required- visit Provost) No
Has the Visiting Scholar been in J-1 or J-2 status in the last 24 months?
Yes, from to No
Is the Visiting Scholar currently in the US?
If yes, please note: The Provost’s office requires this Visiting Scholar application must still be submitted.
Yes, current immigration status No
Does the Visiting Scholar currently have a US visa?
If yes, please note: The Provost’s office requires this Visiting Scholar application must still be submitted.
Yes, current visa type No
Visiting Scholar Application Form
International Student and Scholar Services
300 College Park, Rike Center #204
Dayton, OH 45469-1701
Ph: (937) 229-2748 • Fax: (937) 229-2766
2
Last update: Dec 2018
PART C: APPOINTMENT INFORMATION
Visiting Scholars are invited by "host" departments at the University of Dayton to engage in collaborative
academic projects. These activities can include teaching, lecturing, observing, consulting in connection with a
research project, departmental research, teacher/researcher training, or demonstrating special skills.
Visiting Scholar’s anticipated start date
Visiting Scholar’s anticipated end date
Total length of appointment
What academic field will this work fall under (e.g. theology, biology)?
What is/are the Visiting Scholar’s primary objective(s)?
Research Teaching Observation
Other:
Please briefly describe the activity to be performed by the Visiting Scholar during his/her time here and identify
the specific research area or area of instruction
Note: Based on length of stay and type of appointment, scholar may be subject to HR background check.
PART D: ENGLISH LANGUAGE PROFICIENCY
A new provision requires sponsors to use one of the following objective measures to determine an applicant’s
language proficiency. Please indicate below how you will demonstrate your applicant’s English proficiency:
I have included a minimum TOEFL score of 80 on Internet-based test or 550 on paper-based test OR
minimum score of 6.5 on IELTS; or
I have included signed documentation from an academic institution (other than UD) or English
language school attesting to applicant’s preparedness; or
I conducted an interview either in-person, by videoconferencing, or by telephone and certify that the
applicant possesses the necessary English proficiency to perform the duties of this appointment.
Date interview conducted
Visiting Scholar Application Form
International Student and Scholar Services
300 College Park, Rike Center #204
Dayton, OH 45469-1701
Ph: (937) 229-2748 • Fax: (937) 229-2766
3
Last update: Dec 2018
PART E: FUNDING INFORMATION
Immigration regulations require proof of sufficient supporting funds. ISSS estimates a minimum of $14870/year
($1,240/month) is required to support a single Visiting Scholar at UD. An additional $4,430/year ($370/month) is
required for an accompanying spouse and $2,940 for an accompanying child ($245/month).
UD funding must be in the form of a departmental letter. Non-UD funding must be in the form of a bank statement,
income statement, or letter of guarantee clearly displaying the institution’s name, the scholar’s name, and the
amount, duration, and purpose of the funding.
Type of
Institution/Funding
Full Name of Institution
Amount of Funding for
period of appointment
Does this funding come
in part from
government agencies
to support the scholar
and/or this exchange?
University of
Dayton
****
Yes No
US Government
Agency
Yes No
Exchange Visitor’s
Government
Yes No
Other
Organizations
Yes No
Exchange Visitor’s
Personal Funds
****
Yes No
PART F: DEPENDENT INFORMATION
Dependent 1
Dependent 2
Relationship Spouse Child
Family name
First name
Gender Male Female
Date of birth (mm/dd/yyyy)
City of birth
Country of birth
Country of residence
Relationship Child
Family name
First name
Gender Male Female
Date of birth (mm/dd/yyyy)
City of birth
Country of birth
Country of residence
Note on dependents: If additional dependent children will accompany, please notify ISSS.
If dependent children are included, the Visiting Scholar must specify how the child(ren)’s basic needs will be
addressed while in the U.S.:
What arrangements have you made for your child(ren) to promote their intellectual, social, and physical growth?
Who will supervise your child(ren) while you work?
Visiting Scholar Application Form
International Student and Scholar Services
300 College Park, Rike Center #204
Dayton, OH 45469-1701
Ph: (937) 229-2748 • Fax: (937) 229-2766
4
Last update: Dec 2018
PART G: CERTIFICATION & DEPARTMENT APPROVAL
We certify that, to the best of our knowledge, the information contained in this request form is true and accurate.
Furthermore, we certify that the individual’s program of research/teaching is consistent with his/her professional
background and experience; and
As the sponsor of the Visiting Scholar, we agree that we will:
1) Ensure that the Visiting Scholar completes a background check;
2) Ensure that the Visiting Scholar reports to ISSS within 10 days of his/her arrival to campus;
3) Ensure the Visiting Scholar obtains a Social Security card, if s/he will be compensated;
4) Schedule and accompany Visiting Scholar to appointment with HR (during this appointment,
access will be obtained for campus ID card and Novell login);
5) Ensure that the Visiting Scholar’s activities at UD are consistent with the objectives listed on his/her
invitation letter;
6) Monitor the progress and welfare of the Visiting Scholar, providing any assistance/advice needed to
facilitate the successful completion of the program;
7) Notify ISSS in writing when the Visiting Scholar has completed or withdrawn early from the appointment.
Required Signatures
Fac Sponsor
Signature
Date
Dept Chair
Signature
Date
Dean
Signature
Date
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Completed 18 July 2020

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