ds-2019 application & instructions - madison application.pdfds-2019 application &...
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DS-2019 Application & Instructions Documentation to be submitted to the IFSS Office
(located at 21 N. Park St., Suite 5101) J-1 Exchange Visitor Categories: Professor, Research Scholar, Short Term Scholar and Specialist. It is important for the department to determine the duration of the proposed stay before completing this form.
• Professors and Research Scholars: may extend their stay in the U.S. for up to five years. • Short Term Scholars: may remain in the U.S. for a maximum of only six months and no extension of stay is
permitted. • Specialists: limited to a stay of one year, with an extension possible only under exceptional circumstances
and with Department of State (DOS) approval. IFSS would prefer a minimum of three months processing time for J-1 scholar requests from the time IFSS receives the request until the desired begin date of the scholar’s program. This due to the additional steps the prospective scholar must take to prepare for departure from their home country and arrival to the U.S. Procedures:
Hosting UW-Madison Department • Approves International Visitor invitation/appointment and J-1 status request per internal UW-department
procedures • The UW-department completes DS-2019 request form including attachments • Forwards completed application packet to the IFSS Office via:
o campus-mail o scanned pdf to [email protected]
IFSS Office • Processes completed DS-2019 application packet • Document processing for complete applications is a minimum of 2-3 weeks in the IFSS office. This excludes
mailing time to scholar, timing of consular appointments, airline flights, etc… • Dispatches visitor’s DS-2019 packet as instructed by UW-department (Departmental Pick-up or using a
completed express-mail air-bill provided by UW-department) • After visitor registers at our office, we will copy immigration documents and schedule mandatory orientation
Visitor • Must pay the SEVIS I-901 fee PRIOR to going to the U.S. consulate • Takes DS-2019, passport, UW appointment/invitation letter, and any other required financial documents to
U.S. Consulate to obtain J-1 U.S. visa stamp in passport (exception for Canadian Citizens) • Uses DS-2019 and passport with J-1 U.S. visa stamp to enter the U.S. • Checks in with IFSS Office for mandatory registration as soon as possible after arrival in U.S. • Schedules and attends mandatory J-1 Scholar Orientation • Registers with the SHIP Office and purchases the SHIP Insurance or applies for a waiver of the SHIP
Insurance within 31-days from the arrival date
Checklist of documentation to be submitted to IFSS (Please include completed checklist with request)
IFSS will not process an incomplete application; an incomplete application will result in processing delays. To avoid this, be sure to include:
DS-2019 application form fully completed and signed by the department (all questions must be completed)
Copy of official invitation/appointment letter from the department, on department letterhead, which should include:
Official start-date and end-date of the scholar’s appointment Official UW-Madison academic staff or employee-in-training title Percent appointment and corresponding salary being offered to the scholar Brief description of research the scholar will be doing within the department Signature of the proper hiring authority within the department
Copy of diploma (with translation, if needed. If degree received outside U.S., academic credential evaluation is recommended). Transcripts or a letter from the registrar's office will be accepted in lieu of a diploma.
If not funded by UW-Madison, provide documentation of all funding source(s): e.g. letter(s) from official sponsor or official bank statement (in US$ and in English or with English translation) on letterhead
Proof of English Proficiency
A copy of the passport identity page for prospective J-1 scholar and accompanying J-2 dependents. For J-2 spouse, provide a copy of the marriage certificate. For any J-2 children, provide copies of birth certificates.
If the marriage certificate or birth certificate(s) are not in English, please provide translation(s).
Copy of Curriculum Vitae (CV)
For express mail delivery of DS-2019 to scholar: Completed UPS or FedEx express air-bill. IFSS will not accept express air-bills from other couriers
Special Notes: For J-1 visa holders already in the U.S., a visa transfer may be required. Please refer to the IFSS Website
for further information For applicants already in the U.S. who have a current immigration status other than J-1, a change of
status may be required. Please refer to the IFSS Website for further information For visitors who are MDs: a "5 point" letter signed the Dean or the Dean's designee is required if
the visit will involve incidental patient contact. Please refer to the IFSS Website for further information For information regarding Minimum Financial Support Requirements and Mandatory Health Insurance
(SHIP) Requirements, please refer to the IFSS Website for further information
DS-2019 application (with all required attachments) may be sent to IFSS by one of the following methods: dropped off in person at the IFSS main desk in 21 N. Park St., Suite 5101 campus mailed scanned and e-mailed to [email protected]
Questions: Kim Maday, Program Coordinator: [email protected] Kailee Gawlik, Program Coordinator: [email protected]
DS-2019 Application Form (Documentation to be submitted to the IFSS Office located at 21 N. Park St., Suite 5101)
Names of J-1 scholar and all dependents must appear exactly as in current passport. Provide copy of passport identity pages for scholar and all dependents.
Section 1: J-1 Scholar Biographical Information (Department or scholar may complete. Please print clearly) Name Last/family name first/given name full middle name (if applicable, NO Initials) Gender Male Female Date of Birth
(mm/dd/yyyy) Marital Status Single Married City of Birth Country of Birth Country of Citizenship* Country of Permanent Residence *If scholar has dual citizenship, list country of passport in use for this visit. Current title/position
Current Institution/employer Prospective scholar must have a COMPLETED undergraduate degree to be eligible for UW J-1 Scholar Program * Please provide a copy of your diploma, transcripts, or letter from the registrar's office (with credential evaluation, if necessary) Highest (equivalent) degree completed by scholar Ph.D. Masters MD other (list) Visitor has has not previously been in the U.S. in J-1 or J-2 status. If scholar “has,” list begin and end dates of previous programs, type of J-1 category, and sponsor location.
Scholar’s current mailing address
City/Province
Country Zip Code
Telephone number
Scholar’s E-mail Address
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Section 2: Information about the Scholar’s Dependents • Legally wed spouse and minor, unmarried children under the age of 21.• List ONLY if traveling and entering the U.S. with the scholar. • Include a copy of each dependent’s passport identity page. For the spouse, include a copy of the marriage certificate. For the children, provide a copy of their birth certificates. If documents are not in English, a translation must be provided. • If dependent has dual citizenship, list country of passport in use for this visit.
Dependent 1
Name
Last/family name first/given name full middle name (if applicable, NO Initials)
Gender Male Female Relationship Spouse Child Date of Birth (mm/dd/yyyy)
City of Birth Country of Birth
Country of Citizenship* Country of Permanent Residence
Dependent 2
Name Last/family name first/given name full middle name
(if applicable, NO Initials) Gender Female Relationship Spouse Child Date of Birth (mm/dd/yyyy)
City of Birth Country of Birth
Country of Citizenship* Country of Permanent Residence
Dependent 3
Name Last/family name first/given name full middle name
(if applicable, NO Initials)
Male Female Relationship Child Date of Birth (mm/dd/yyyy)
City of Birth Country of Birth
Country of Citizenship* Country of Permanent Residence
Dependent 4
Name Last/family name first/given name full middle name
Gender Male Female Relationship Child Date of Birth
(mm/dd/yyyy)
City of Birth Country of Birth
Country of Citizenship* Country of Permanent Residence
J-2 Email Address (if applicable)
J-2 Email Address (if applicable)
Gender Spouse
(if applicable)
Male
J-2 Email Address
(if applicable, NO Initials)
(if applicable) J-2 Email Address
Spouse
J-1 English Proficiency Requirement
The U.S. Department of State has mandated that J-1 exchange visitors including short-term scholars, research scholars, professors, and specialists have sufficient English proficiency [22 CFR §62.10(a)(2)].
Sponsors must establish and utilize a method to screen and select prospective exchange visitors to ensure that they are eligible for program participation, and that:
(1) The program is suitable to the exchange visitor’s background, needs, and experience; and,
(2) The exchange visitor possesses sufficient English proficiency as determined by an objective proficiency
measurement to successfully participate in his or her program and to function successfully on a day-to-day basis.
The host faculty must verify an applicant’s English language proficiency through a recognized English language test, by signed documentation from an academic institution or English language school, or through a documented interview conducted by the sponsor either in-person or by videoconferencing. If the host faculty member cannot firmly establish sufficient English proficiency, then it is not appropriate to request a DS-2019 for the J-1 exchange visitor, as s/he is not eligible for J-1 status.
To comply with this regulation, the host faculty must submit documentation of a prospective J-1 scholar’s English proficiency as part of the DS-2019 request process. IFSS will not issue a DS-2019 without valid documentation. Once the scholar arrives at the UW, if IFSS deems that their English proficiency does not meet requirements or was misrepresented, the J-1 scholar’s program will be terminated. The English proficiency requirement can be satisfied by submitting documentation of at least one of the following:
1) Copy of diploma/degree from U.S. or foreign institution where the instruction occurred in English. If diploma/degree is
more than five years old, IFSS may require additional details or documentation to show continuing use of English.
2) A signed letter from an academic institution or English curriculum school that is internationally recognized that states the prospective visitor’s level of English proficiency. This letter cannot be from the UW-Madison hosting department. Letter must be dated within the last two years, state the scholar’s affiliation with the school, and affirm the visitor achieved at least intermediate skills.
3) Copy of official scores or transcript containing a photo and birthdate from one of the following English language tests taken within
the last year and meeting the stated minimum scores below. No other testing scores or certificates from other centers or English language schools will be accepted.
If a scholar has taken the TOEFL or IELTS within the past year, a copy of all official scores must be included. If the TOEFL or IELTS score does not meet IFSS standards, the scholar must retake the TOEFL or IELTS and receive a
passing score before their application will be considered. An interview will not be accepted.
TOEFL: iBT-65 total (with the speaking portion scoring no less than 17) Paper-525 total IELTS: 6 total with no portion scored less than 5
4) J-1 English proficiency interview assessment report (see template on the following page) from an interview conducted in English by the hosting faculty member. This can be done in person or by a videoconferencing method such as SKYPE. The host faculty member must be proficient in English. The interview must include the questions listed on the following page. Additionally the interview must also include three questions focusing on the J-1 program content (research work, area of specialization, appointment directives). The interview assessment must be completed in full with no assessment comments or signatures left blank. The scores should be based on the TOEFL independent speak rubric scoring standards that are on the following page. The assessment comments should detail the answer to the individual questions as well as how the answer relates to their English proficiency.
IFSS reserves the right to determine English proficiency on a case by case basis.
J-1 English Proficiency Interview Assessment Report
Prospective Scholar: Country of Citizenship:
Host Faculty Name: _ Department:
Date of Interview:
Interview Method: In Person By videoconferencing
Question Score Assessment Comments
Please share a little about your previous experiences traveling and/or living abroad. If you have not traveled outside your home country, please share a little about what you will do to prepare for your time in the U.S.
What motivated you to pursue a research position at the University of Wisconsin - Madison?
What do you think will be the most challenging aspect of living and working in the U.S. ?
How do you think that the time you spend at the University of Wisconsin -Madison will benefit you personally and professionally?
Please enter 3 additional J1 program content-area questions and questions developed to gauge whether the prospective scholar will be able to function on a day to day basis in the U.S. and this specific J1
Host Faculty’s Overall Assessment Host Faculty Member’s Signature:
Department Chair/Department Administrator:
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Section 4: Appointment Information (UW-Madison host department must complete)
Eligibility for J-1 Scholar categories: Professor, Research Scholar, Specialist, or Short Term Scholar (Short Term Scholar is limited to maximum of 6 months)
IMPORTANT: Check one box below
• Visit will be 6 months or longer (Research Scholar/Professor), check here • Visit will be 6 months or less (Short-Term Scholar), check here
Dates of Program Beginning Ending (mm/dd/yyyy) (mm/dd/yyyy)
Host Department
UW Academic Staff Title offered Will the scholar have a position with a PVL listing? If so, please give the PVL number:
Give a non-technical description of the scholar's job duties (required) and research project (if applicable): Give a non-technical desc
Visitor's primary UW activity Teaching Research Observation Consultation Visitor’s site of activity:
Visitor’s field of specialization (see list)_________________________________________________________
Visitor will be supervised at UW-Madison by
Supervisor's telephone E-mail
If J-1 will have multiple worksites, please let us know.
)_________________________________________________________
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Section 6: Department Approval (Must be signed by department hiring authority)
The person who is named as the Primary Department Contact will receive all correspondence regarding this request.
Name & Title of Department Hiring Authority Primary Department Contact Person
Hiring Authority Signature Contact Telephone
Date Contact E-mail Address
Department Mailing Address Secondary Department Contact Person
Contact Telephone
Contact E-mail Address
Dispatch Instructions:
Departmental Pick-up. (Department is responsible for picking up and mailing the documents to the J-1 Scholar in a timely manner.)
Express or courier service to visitor. IFSS will only accept a completed UPS or FedEx air-bill.
Attach Completed express mail air-bill
UW-Madison salary/stipend, if any $ per month duration of program
The UW-Madison sponsor has has not received funding from U.S. Government Agency(ies) to
directly support this exchange visitor’s program. If “has” indicate agency(ies) below. *U.S. government funding does not include“general” grants in which professors can spend the funding as they
deem necessary, from office materials to a UW-salary, in order to achieve research results.
U.S. Government (list agency) $ per
International Organization (list agency) $ per
Visitor's home Government $ per
Visitor's personal funds $ per
Other (specify) $ per
Total $ per
Section 5: Funding Information (in US dollars) Attach: letter(s) or official bank statement in English to substantiate each funding source below