This form should be used for all participants in the Specialist, Short-Term Scholar, and Professor designations. This form
must be signed by the Hosting Department Dean the Campus President. Submit this form with the application forms.
Applicant Information:
J Visa Designation: Professor (3 wks. to 5 yrs.) Short-Term Scholar (1 day to 6 mo.) Specialist (3 wks. to 1 yr.)
Family Name: ______________________________________ First Name: ___________________ Middle Name: ___________
Start Date: _______________________________________ End Date: ___________________________________________
Department Contact Person: ______________________________________________________ Phone: ____________________
Department / Program of Study: _______________________________________________________________________________
Provide a description of the project and your role; i.e., what will you study/teach/research?
Sponsoring Department Responsibilities:
Prior to Arrival:
Designate a contact person in the department. Provide his or her phone number and email address to facilitate communication
and help make arrangements for the visitor.
Secure funding sources for the Visitor if required.
Coordinate accommodation needs for the Visitor.
Ensure that the Visitor has received specific information about the department, as well as projects and responsibilities. Have a
written letter of agreement with all projects and responsibilities assigned.
Locate and reserve an office and/ or laboratory space for the Visitor (if needed), along with the use of computer, email and library
access. Arrange for administrative and other essential support if applicable.
Upon Arrival:
Ensure that the Visitor reports to the RO/ARO upon arrival to Valencia in order to submit copies of all immigration documents
and provide proof of health insurance.
Contact the office of International Student Services (ISS) when a Visitor will be delayed in arriving at Valencia, has left the coun-
try, and/or has completed his or her work with the department.
Coordinate the Visitor’s attendance to the orientation sessions.
Coordinate attendance to a variety of events to help the Visitor assimilate to the U.S. and college culture.
Contact the office of International Student Services 45 days prior to the completion of a Visitor’s program if the department
wishes to request an extension of stay. A new DS-2019 request form along with supporting documents must besubmitted.
Hosting Department Administrator (DEAN) please complete: By signing this form, you agree that your department will
ensure that the above responsibilities are met.
Name of professor assigned to work with Exchange Visitor: _________________________________________________________
Funding source/s if the Exhchange Visitor will be paid: _____________________________________________________________
Campus and Office Location for Visitor: _________________________________ Ext.: ___________________________
Dean Name: ____________________________ Signature: ______________________ Date: ________________
Campus President Name: ____________________________ Signature: ______________________ Date: ________________
Hosting Department Sign-Off Form
click to sign
signature
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