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
Describe project here.
click to sign
signature
click to edit
click to sign
signature
click to edit