Checklist for Certificate of Eligibility for J-1 Status (Form DS-2019)

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1 Checklist for Certificate of Eligibility for J-1 Status (Form DS-2019) The purpose of the J-1 program is to provide foreign nationals with the opportunity to participate in educational and cultural programs in the US. It is designed to enhance their experience while contributing to their development. The exchange program encourages US professionals to participate in similar programs abroad. This program is intended for professors, research scholars, and or professionals seeking to enlighten their development in the U.S. The maximum period of entry for short- term scholars is six (6) months. Extensions beyond this period are not authorized. Unlike the other J-1 categories, there is no minimum period of stay in the U.S. The following documents must be included with this application: Copy of Letter of good academic standing from Dean of current medical school. Copy of updated Curriculum Vitae Proof of health insurance valid for the duration of visit and valid in the U.S. The Exchange Visitor regulations specify a minimum level of coverage. o Medical benefits of at least $50,000 per accident or illness o Repatriation of remains in the amount of $7500 o Expenses associated with medical evacuation of the Exchange Visitor to his or her home country in the amount of $10,000 o A deductible not to exceed $500 per accident or illness. Copy of biographic page in unexpired passport Proof of financial funding. For all exchange visitors with funding sources other than Mount Sinai, please attach documentation such as a letter from sponsors, universities or government agencies, bank statement showing funds available for the duration of your stay. If the funding is coming from two different sources please distinguish. The document must be in English and contain the following: Name of applicant and relation to the funding sponsor The period of time the funding will be granted The amount of financial support in U.S. dollars. (Minimum of $1600/month) The document must be notarized, on official letterhead of the supporting organization and must be signed by an authorized official of the organization. Copies of all prior issued visas including DS-2019 forms, etc. $200 Disbursement Fee. Payment should be made directly to the Main Cashier upon arrival. Payment is accepted in the form of check or money order payable to Mount Sinai Medical Center. No credit card payments are accepted. Deposit Invoice attached.

2 Checklist Certificate of Eligibility for J-1 Status (Form DS-2019) cont d If immediate family members (such a spouse and children under 21 years of age) will accompany the exchange visitor, please include a copy of marriage certificate and birth certificate of children to establish proof of relationship. Completed applications and supporting documents may be submitted via air Courier Service: Postal Service: Mount Sinai Medical Center Mount Sinai Medical Center International Personnel International Personnel Attn: Yovanna Torres Attn: Yovanna Torres 320 E 94 th Street, 5 th Floor One Gustave L. Levy Place New York, NY Box New York, NY Please submit all required documentation and allow at least three (3) weeks for processing. Incomplete applications will cause delay. The office of International Personnel will communicate any request for additional documentation directly to the exchange visitor via . While request try to prioritize cases on first come first serve basis, priority will be given to the start date requested. It is important that you read and understand the following. Once you obtain the SEVIS generated form DS-2019 you will require scheduling an appointment with the US embassy to apply for the J-1 visa. You will require taking with you your passport, form DS-2019 and the I-901 SEVIS fee receipt. As an initial participant in an exchange visitor program, you will be required to pay a mandatory remittance fee (SEVIS I-901 fee) of $100 authorized by Public Law , subtitle D. section 641. This fee is required for the maintenance of the Student Exchange Visitor Information System (SEVIS). If you do not pay the fee and appear for your interview at the embassy without proof of payment, your visa will not be issued. You can make this payment online with a credit/debit card at Visa issuance processing times at consulates vary and you should plan your trip accordingly. It is recommended that you secure your visa before making travel arrangements.

3 Complete and submit this portion only with the required documentation to International Personnel. Application for Certificate of Eligibility for J-1 sponsorship Please specify the purpose of the Exchange Visitor s status: Requested Period of Elective: From / / To / / Mo. Day Year Mo. Day Year Part I: Exchange Visitor s Biographic Information (PLEASE PRINT) Name: Family Name First/Given name Middle Name Male Female Date of Birth: / / Month Day Year Place of Birth: City, State or Province Country Country of Citizenship: Country of Legal Permanent Residence: Permanent Foreign Address: (required) Current U.S. Address: (Upon Arrival) Home Telephone: Work Telephone: Mobile: Exchange visitor s most recent position in home country: If student, please specify by checking the following: Undergraduate Graduate Medical Has you ever applied and been approved for a U.S. visa? If so, when and on which type of visa status?

4 Part II: Financial Support Information 1. Source and Breakdown of Support: (If the institution will be paying the employee directly, please confirm that the funds will be deriving directly from Mount Sinai. If the funding is coming from two different sources please distinguish. The minimum funding requirements for a J-1 exchange visitor is $1,600 per month. Funding listed below is: Per month For the duration of the stay Source of Funds Amount of Funds* Name of Funding Source Mt. Sinai School of Medicine U.S. Government Agency International Organizations Exchange Visitor s Gov t** Other Organization s providing support Personal Funds * Indicate Total amounts of funds in USD ** Check only if the individual is receiving funds DIRECTLY from a U.S. Government Agency If non-salaried, will the institution provide medical coverage that meets the J-1 exchange visitor regulations minimum requirement? Yes No. If No, exchange visitor must submit a health insurance policy that medical coverage has been secured for self and family during the dates of participation. ********** Health insurance is required before DS-2019 is issued. **********

5 Part III: Exchange Visitor s Work Site Duties Is this Exchange Visitor a graduate of a foreign medical school? Yes No If Yes, indicate the level of clinical care in which this individual will perform: A. The program in which the physician will participate involves clinical training or clinical research. If A is checked please STOP. The individual must be sponsored by the Educational Commission for Foreign Medical Graduates (ECFMG) or apply for an H-1B visa. Note: To qualify for the H-1B category you must have passed all three steps of the USMLE examination and have the appropriate licenses. For information on how to contact ECFMG, or how to apply for an H-1B visa, please contact the office of International Personnel at (212) B. The program in which the physician will participate involves no element of patient care services. C. The program in which the physician will participate involves incidental patient contact. All such patient contact will be under the supervision of a physician who is a U.S. citizen or permanent resident who is licensed to practice medicine in the State of New York. The foreign physician will NOT be involved in or responsible for the diagnosis and/or treatment of patients. The foreign physician will NOT be involved in any patient care activity, which would normally require a medical license. No experience gained in this program will be creditable toward any clinical requirements for medical board certification. (Please note that graduates of medical schools cannot be registered as or treated as medical students for patient care services.) ***PLEASE ATTACH DEAN S STATEMENT IF LETTER C SELECTED***

6 Part V: Information about Exchange Visitor s Dependent Family Member(s) A. Spouse Information: Name of spouse: Family Name First/Given name Middle Name Male Female Place of Birth: City, State or Province Country of Citizenship: Country of Permanent Residence Spouse will travel with exchange visitor. Date of Birth: / / Month Day Year Country Spouse will arrive later. Expected arrival date, if known. Spouse is already in the U.S., and will need a transfer, extension, or change of status. Please specify:. B. Children Information: Name of Child: Family Name First/Given name Middle Name Male Female Date of Birth: / / Month Day Year Place of Birth: City, State or Province Country Country of Citizenship: Country of Permanent Residence Child will travel with exchange visitor. Child will arrive later. Expected arrival date, if known. Child is already in the U.S., and will need a transfer, extension, or change of status. Please specify:. *** If there are more children please add an additional page. *** Note: All J visa applicants must have an intention to return to their home country.

7 Part VI Faculty Information and authorization of sponsorship. Without the following authorization from the faculty sponsor, the DS certificate of eligibility cannot be issued to the exchange visitor. Full Name of Faculty Sponsor: Full Name of Exchange Visitor: THE UNDERSIGNED CONFIRMS that he or she is authorized to offer this position, that he or she will take responsibility for the supervision of the visitor, and that the information contained in this request is accurate to the best of his or her knowledge. Signature of Faculty Sponsor: Date: Department: Location: Contact Person: Telephone: Address: Fax: Please Note: While request try to prioritize cases on first come first serve basis, priority will be given to the start date requested.

8 DEPOSIT INVOICE To: From: Main Cashier, Mount Sinai Medical Center International Personnel Re: Deposit into account Please deposit the funds listed below at the main cashier located at Guggenheim Pavilion, 1st floor, East Tower. The receipt should be brought back to International Personnel for case processing. ALL checks and money orders are to be made payable only to: The Mount Sinai Medical Center Method of Payment ڤ Cash ڤ Money Order ڤ Check # ڤ $200 J1 processing Fee Petitioner s LAST Name Petitioner s FIRST Name Date OFFICE USE ONLY Case # Code: Signature/Date