Fillable Western Carolina University Office of International Programs and (Western Carolina University)

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Western Carolina University Office of International Programs and (Western Carolina University)

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Western Carolina University
Office of International Programs and Services Request for J-1 Visa Document
The purpose of the J-1 exchange visitor visa for professors, research scholars, and short-term scholars is to facilitate international
collaborative teaching and/or research efforts. Visitors (who must typically have training at the master’s level or higher) are invited to the
U.S. for a program with a specific objective and length of stay from minimum of three weeks to maximum of five years. All J-1 exchange
visitors at WCU are required to have at least a master’s degree in a related field and have demonstrated relevant experience in their field
of expertise.
To ensure that your visitor will be able to arrive on schedule, this form should be completed three months prior to the anticipated date of
arrival to allow adequate time for processing and obtaining visas.
Part 1. Visiting Professor/Research Scholar Information (to be completed by visitor)
Family Given Middle Male
Name: Name: Initial: Female
Date of City of Country of
Birth (mm/dd/yyyy): Birth: Birth:
Country of Country of legal permanent residence
Citizenship: (if other than country of citizenship):
Visitor’s job title and name of institution in
home country:
Are immediate family members Yes If yes, please also complete the attached
accompanying your visitor (spouse and/or children)? No “Dependent Information Form” (Part 9)
Please identify visitor’s primary activity at WCU: Teaching Research Other (please specify)
Period of visitor’s program
at WCU (mm/dd/yyyy): From:
To:
Brief description of your primary program
activity (e.g., research in quantum theory ) at WCU:
Visitor’s primary
work location at WCU (e.g., College of Business):
List any previous time in the U.S. in J-1 or J-2
status in the past three years: From: To: Status:
Please provide visitor’s
address for mailing purposes:
Pho
ne: ______________________________ E-mail: ____________________________________
Part 2. Complete only if visitor is already in the U.S. (to be completed by visitor)
Current Date of entry Attach copy of visitor’s I-94 card and, if in J-1 status,
visa status: to the U.S.: any previous DS-2019 forms.
Part 3. Funding sources (to be completed by visitor)
A minimum of $15,000/year for visitor, $8,000/year for spouse (or first dependent), and $5,500/year for each child must be documented.
List amount and source(s) of funding.
Western Carolina University Is funding availability certain for Yes
salary or stipend (if applicable): the amount of time requested? No
Other funding Funding
(in U.S. Dollars): Source:
Part 4. Processing information (to be completed by the hosting department)
How shall we forward the Call dept. for pickup Dept. phone: _____________________
J-1 DS-2019 after it is ready (please only select one)? Campus mail to dept. Campus address__________________
FedEx/
UPS u
sing your account #:________________________
continued on reverse…
Part 5. Information needed to ensure compliance with J-1 regulations (to be completed by the hosting department)
If your visitor will receive WCU funds, indicate J-1 visitors may not be appointed to technician positions
how the funds will be disbursed: and may not be candidates for tenure.
Honorarium
Reimbursement of expenses
Salary
Other
All J-1 exchange visitors and their J-2 dependents are required to have medical insurance. If no other insurance is available, the visitor
must enroll in WCU’s mandatory health insurance program for international students and scholars. The 2014-2015 rate is $87.60 per
month. Dependent insurance costs are higher.
Please indicate your understanding of how this requirement will be met (please only select one):
WCU
employee health insurance benefits, paid by the Department
Department will purchase insurance through international students and scholars plan: for visitor only for visitor and
dependents
Visitor is responsible for all insurance costs.
Other (please explain): _____________________________________________________________________________
Part 6. Required Documents.
Please submit the following documents with this form to Ling Gao LeBeau, Office of International Programs and Services, Camp 109 (to be
sent by the department)
1. Original letter of invitation to your visitor outlining program objectives and period of duration. Please see J-1 Guidelines for sample
Appendix A.
2.
C
opy of visitor’s CV
3.
Copy of completed Form “Request for J-1 Visa Document.”
4.
Documentation of funding from funding source
6.
Copy of visa documentation if visitor is already in the U.S. (See Part 2).
Part 7. Responsibilities of host unit.
By signing this form, you, as representative of the host unit, agree to do the following:
1. I understand federal law restricts the sharing of certain technologies and software with foreign nationals. These rules are complex and
substantial penalties may be imposed for violations. If the visitor may have access to export controlled technology or software
controlled by federal law, the hiring unit should contact the Office of University Counsel to ensure that all applicable requirements are
met.
2. I understand that I am to have the J-1 visitor report to the Office of International Programs and Services for check-in and orientation
within one week of arrival.
3. I understand that I am to encourage your visitor to participate in the academic and social activities of my unit as well as in cross-
cultural activities on the campus and within the community.
4. I understand that I am to notify International Programs and Services when my visitor completes his/her program, if there is a significant
change in the program, or if termination of the visitor’s program become necessary.
Part 8. Signatures.
This is to verify that the information contained in this form is correct to the best of my knowledge and that I agree to the responsibilities
outlined in Part 7. I also certify that the purpose of this exchange visitor’s program is to stimulate international collaborative teaching and/or
research efforts and that funding is guaranteed for the period of time requested.
Name and Title of Host professor: Name of Academic Department
Email Pho
ne Campus Address
Signature:_____________________________________________________Date:___________________________
Name of College/School Dean: ____________________________________Signature: ___________________________ Date
Provost Signature: Date:
2
Part 9. Dependent Information Form. Complete this page for all dependents accompanying your visitor to the U.S. Please notice that
only spouse and children (under 21) are considered dependent for the purpose of visa processing.
Family Name: Given Name: Middle:
Date of Birth (mm/dd/yyyy): City of Birth: Country of Birth:
Country of legal permanent residence:
Country of citizenship
Relationship to visitor:
Family Name: Given Name: Middle:
Date of Birth (mm/dd/yyyy): City of Birth: Country of Birth:
Country of legal permanent residence:
Country of citizenship
Relationship to visitor:
Family Name: Given Name: Middle:
Date of Birth (mm/dd/yyyy): City of Birth: Country of Birth:
Country of legal permanent residence:
Country of citizenship
Relationship to visitor:
Family Name: Given Name: Middle:
Date of Birth (mm/dd/yyyy): City of Birth: Country of Birth:
Country of legal permanent residence:
Country of citizenship
Relationship to visitor:
Family Name: Given Name: Middle:
Date of Birth (mm/dd/yyyy): City of Birth: Country of Birth:
Country of legal permanent residence:
Country of citizenship
Relationship to visitor:
3
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Completed 24 July 2020

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