J-1 Scholar Initial Request Form

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1 International Students and Scholars Office Cornell University B-50 Caldwell Hall, Ithaca, NY Telephone: Fax: Web: J-1 Scholar Initial Request Form THIS IS NOT AN IMMIGRATION DOCUMENT. DO NOT SEND IT TO YOUR VISITOR--it will not enable him/her to obtain a visa. All questions must be answered in full to avoid delays in processing Form DS Please type or print. This form must be completed by an HR representative. Important Information Please Read: J-1 Professor/Research Scholar Category Eligible for 5-year maximum stay in teaching, research, or both. J-1 Short Term Scholar Category Eligible for 6-month maximum stay, no extensions or changes of status to another visa classification within the US allowed. 2-Year Repeat Participation Bar J-1 Professors or Research Scholars are now required to have a gap of 2-years between the end of any previous J-1 Professor/Research Scholar Program (ending 11/18/2006 or later) and the beginning of any new J-1 Professor/Research Scholar Program. Therefore, those beginning new programs that will include repeat visits should have their programs extended for the full duration of their program/collaboration, up to the 5 year maximum, even if portions of that time will be spent outside the US. For those not eligible for a new J-1 Professor/Research Scholar program, consider whether the J-1 short-term scholar (see above) will meet your needs. 12-Month Bar An individual who has been in any category of J status (including J-2 and J-1 student) for more than 6 of the 12 months immediately preceding the new program start date, is ineligible for a J-1 Professor/Research Scholar category. For those not eligible for a new J-1 Professors or Research Scholars program, consider whether the J-1 short-term scholar (see below) will meet your needs. 2-Year Home Residency Requirement Will apply to any J-1 who receives US or home country government funding for the exchange (note that salary from federal grants is not considered government funding unless the funding was provided for the purpose of the exchange), or who is participating in a field of specialization which their home country has listed on the US Department of State s Skills List. Affected individuals are not eligible for H1B (or L) visas, for US permanent residence, for changes of visa classification within the US, unless they return home for 2 years, or obtain a waiver of the requirement. They are not prohibited, however, from new J programs, or other visa classifications. Please consult with the ISSO, if you have any questions about these requirements. Required Information: 1. NAME OF INTERNATIONAL EXACTLY AS WRITTEN ON HIS/HER PASSPORT* (obtain copy for your records): [*If the name is not exactly as it is written in the passport, the visitor may be denied a visa.] Family (Last) Given (First) Middle 2. DATE OF BIRTH (month) (day) (year) 3. GENDER: [ ] MALE [ ] FEMALE 4. PLACE OF BIRTH (city) (country) 5. COUNTRY OF CITIZENSHIP: 6. COUNTRY OF LEGAL PERMANENT RESIDENCE: 7. CATEGORY REQUESTED (check one, see above for details) Professor/Research Scholar (5-years maximum, 2-year repeat participation rule applies) Short-Term Scholar (6-month maximum, 2-year repeat participation rule does NOT apply, but no extensions or changes of status within the US e.g. to H1B possible) 1 Rev. 01/2007

2 8. Does the International Visitor have a Ph.D.? [ ] YES [ ] NO If no, please note that all J-1 scholars have CU academic titles. If a PhD is not required for the academic title, the J category may be utilized. It is the responsibility of the appointing academic department to determine the appropriate academic title and to ensure the visitor meets all educational requirements for that title before the DS-2019 request form is submitted to the ISSO. Has the visitor been in J-1 student, scholar or J-2 dependent status within the last 2 years? [ ] YES [ ] NO If yes, please provide copies of the visitor's previous DS-2019 forms 9. COMPLETE FOREIGN ADDRESS: (required) 10. VISITOR'S , PHONE & FAX Phone Fax: 11. CU Host Department Contact and Information: Appointing Department: Department H.R. Contact Name: phone: 12. CURRENT POSITION IN HOME COUNTRY Was/Is the employer [ ] Educational Inst. [ ] Private Business [ ] Central Gov't. [ ] State Gov't. [ ] Regional Gov't. [ ] City Gov't. 13. LENGTH OF THE ACADEMIC APPOINTMENT: Start date:* End Date: The academic appointment at Cornell must be for the entire period specified above. Financial support information must be for this period. The total time allowed in the U.S. in J-1 scholar status is 5 years. Even if your visitor will not be on payroll, because of his/her visa status University policy requires that your department give your visitor an academic appointment. *NOTE REGARDING START DATE: J1 Scholars must enter the U.S. and report to Cornell no more than 30 days before and NO MORE than 30 days after the start date on the DS Please contact us if a scholar's plans change and he/she will not arrive in time. 14. Subject / Field of Visitor's Primary Area of Activity at Cornell (choose from attached list): Field #: Cornell Title: Primarily Teaching or Research? (circle one) Field Description if NOT found in attached list: 15. Physical Address of on campus work location: 16. Physical Address of any off campus work location: 17. J-2 Dependents: Dependents who will be accompanying J-1 visitor: Name (First, Middle, Last) Date of Birth (mo/day/year) Country & City of Birth Country of Citizenship Country of Legal Permanent Res. Gender M or F Relationship

3 SOURCE(S) AND AMOUNT OF FINANCIAL SUPPORT FOR VISITOR'S ENTIRE STAY The U.S. Government requires Cornell to verify adequate financial support and health insurance for international visitors and their accompanying dependents. See below for minimum amounts required. It is the hosting academic department's responsibility to verify that ALL exchange visitors meet minimum funding guidelines and are covered by medical insurance. Please note that medical insurance is a U.S. Government requirement. 18. MINIMUM FUNDING REQUIREMENTS:* Source of Financial Support $1,100. / per month for individual (Enter amount in US$ for the entire period of stay) $550. / per month for spouse $ Cornell University $275. / per month for each child $ International Organization $1000 / initial adjustment expenses (state source) $ U.S. Gov't Agency** *This funding may come from any source (state source) including the visitor s personal savings or $ J1 Scholar's Government Cornell salary. These amounts represent $ All other organizations the bare minimum and do not include the (state source) cost of health insurance coverage, which $ Personal Funds could range from $60 to $200 per month for a family. **U.S. Government Funding: The Exchange Visitor is considered to be government funded ONLY if s/he received funds directly from a U.S. Government agency. When individuals are supported through government funds paid to a Cornell professor, department, or grant, this is NOT considered to be direct government funding. Receipt of government funding will subject the J visitor to the 2-year home residency requirement. SUBMISSION OF THIS REQUEST FORM: By FAX By Campus Mail - To: Exchange Visitor Program Dept: ISSO Building: Caldwell, B50 ONCE THIS REQUEST IS COMPLETED AND THE DS-2019 FORM(S) PRODUCED The ISSO will mail the DS-2019 form to the international by regular airmail only. If you prefer to send the form by express mail, please pick up the form from the ISSO. PLEASE CHECK YOUR PREFERENCE BELOW: DEPARTMENT PICKS UP and SENDS FORM ISSO SENDS FORM (provide mailing address, if different from visitor s foreign address, provided at #9 HR Representative Signature: Sign date

4 J1 Academic Staff Field Descriptions (with CIP 2000 codes) Math, Science & Engineering Math, Science & Engineering (cont'd) OOOO O Aerospace Engineering Agricultural & Food Products Processing Agricultural/Biological Engineering & BioEng. Agriculture Animal Health Animal Sciences, General Applied Mathematics Astronomy Astronomy & Astrophysics Astrophysics Atmospheric Physics & Dynamics Atomic/Molecular Physics Biochemistry Biochemistry / Biophysics & Molecular Biol. Biological & Physical Sciences Biometry/Biometrics Biotechnology Botany / Plant Biology & Anatomy Cell Biology Chemical Engineering Chemical Physics Chemistry Civil Engineering Computer Engineering Computer Graphics Computer Science Crop Production Ecology, Evolution, Systematics & Pop. Biol. Electrical / Electronics & Commun. Eng. Engineering Physics Entomology Environmental Studies Environmental/Environmental Health Eng. Floriculture / Floristry Oper. & Management Food Science Food Science & Technology, Other Foods, Nutrition & Related Services Genetics, General Geology / Earth Science Horticultural Science Industrial Engineering Information Technology International Agriculture Materials Engineering Materials Science Mathematics, General Mechanical Engineering Molecular Biology Molecular Genetics Molecular Pharmacology Molecular Physiology Natural Resources / Conservation, General Neurobiology & Neurophysiology Nuclear Engineering Nuclear Physics Nutrition Sciences Operations Research Ornamental Horticulture Physics, General Plant Genetics Plant Molecular Biology O OO Plant Pathology / Phytopathology Plant Sciences, General Polymer Plastics Plasma & High-Temperature Physics Science, Technology & Society Soil Science & Agronomy Solid State and Low-Temperature Physics Veterinary Biomedical & Clinical Sciences Veterinary Infectious Diseases Veterinary Medicine Veterinary Microbiology Veterinary Microbiology & Immunology Veterinary Pathology Veterinary Physiology Veterinary Sciences/Veterinary Clinical Sci. Wildlife & Wildlands Science & Management Wildlife Biology Social Sciences and Business Administration Agricultural Economics Agricultural & Extension Education Services Anthropology Anthropology, Other Applied Economics Business Administration & Management City/Urban, Community & Regional Planning Economics, General Education, General History Hotel/Motel Administration/Management Human Development & Family Studies Human Resources Management/Personnel Labor & Industrial Relations Law (LL.B., J.D.) Management Science, General Marketing / Marketing Management, General Organizational Behavior Studies Peace Studies & Conflict Resolution Public Policy Analysis Political Science & Government Psychology, General Social Sciences Sociology Statistics, General Statistics, Other Humanities African Studies American/United States Studies/Civilization Art History, Criticism & Conservation Asian Studies/Civilization Classical, Ancient Med. & Near East Studies Classics & Classical Languages, Lit & Ling. Communication, Journalism, and Rel. Prog. Communication & Media Studies Communication Studies, Spch, Com. & Rhet. East Asian Studies English Language & Literature, General European Studies/Civilization Updated July sh

5 J1 Academic Staff Field Descriptions (with CIP 2000 codes) Humanities (cont'd) OO French Language & Literature German Studies Humanities/Humanistic Studies Korean Studies Latin American Studies Linguistics Linguistic, Comparative and Rel. Lang. Stud Near & Middle Eastern Studies Philosophy Romance Languages, Literatures & Ling. South Asian Studies Southeast Asian Studies Women s Studies Library Science O Creative and Performing Arts, Architecture & Design Apparel & Textiles, General Architecture Architectural History Art Cinematography & Film/Video Production Dance Environmental Design/Architecure Film/Cinema Studies Interior Design Landscape Architecture Theater Library Science / Librarianship Library Assistant / Technician Updated July sh

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