USF Exchange Visitor/Scholar REQUEST FORM

USF Exchange Visitor/Scholar REQUEST FORM Office of International Services, USF World 4202 E Fowler Ave, CGS 101, Tampa, FL 33620 Phone: 813-974-5102 Fax: 813-974-0491 The Office of International Services (OIS) is responsible for administering, approving and signing all documentation connected with the J-1 Exchange Visitor Program at the University of South Florida (P-1-03445). This program brings qualified scholars to the United States for teaching, research, observation, consultation, and cross-cultural activities. USF s J-1 program is authorized to issue DS-2019 forms in the following scholar categories: SHORT TERM SCHOLAR: A professor, research scholar, or other individual with similar education or accomplishments coming to the US for a short-term visit of 1 day to 6 months to lecture, observe, consult, train, or demonstrate a special skill at USF. The individual must have a Bachelor s degree at a minimum that matches the planned academic activity at USF. RESEARCH SCHOLAR: An individual primarily conducting research, observing or consulting in connection with a research at USF from 3 weeks to 5 years in duration. The individual must have a Bachelor s degree at a minimum that matches the planned academic activity at USF. This is not for a USF tenure track position. PROFESSOR: An individual primarily teaching, lecturing, observing or consulting at USF from 3 weeks to 5 years in duration. The professor may also conduct research if stated in the application process. The individual must have a Bachelor s degree at a minimum that matches the planned academic activity at USF. This is not for a USF tenure track position. SPECIALIST: An individual who is an expert in a field of specialized knowledge or skill coming to the US for observing, consulting, or demonstrating this knowledge or skill for from three weeks to one year. The individual can receive a stipend if arranged prior to the visit but cannot fill a line position at USF. 12 Month and Two Year Bars for Research Scholars and Professor Categories J-1 exchange visitors in any J category other than short-term scholar who were in the US for a period longer than 6 months at anytime within the past 12 months are not eligible to return as a J-1 Research Scholar or Professor until one year has elapsed from last exit in J-1 status. In addition, J-1 exchange visitors using the Research Scholar or Professor categories are not eligible to return as a J-1 Research Scholar or Professor until two years has elapsed from the date of last exit from the U.S. If this will affect your proposed scholar, contact OIS to discuss possible alternative options. The Two Year Home Residency Requirement Upon completion of an exchange visitor program in the US, certain J-1 exchange visitors are required to live in their home country for a period of 2 years before they are eligible to apply for immigrant status or US work visas. This requirement applies to exchange visitors who (1) are financially supported by the U.S. or home government; or (2) have skills which are needed in the home country, as specified on the Exchange Visitor Skills List; or (3) are medical doctors who have graduated from a foreign medical school and have come to the United States to study or work in the field of medicine. Scholars will be given information on how to fulfill this requirement during orientation. Health Insurance Requirement Scholars and their dependents (spouse and children) are required to carry medical insurance that meets specific federal minimum requirements for the duration of the program. Failure to maintain active health insurance can result in termination from the program. Minimum requirements are: *Medical benefits of at least $100,000 per accident or illness *A deductible not to exceed $500 per accident or illness. *Repatriation of remains in the amount of $25,000 *Medical evacuation to the home country in the amount of $50,000 It is strongly recommended that the department and/or scholar use the university s Scholar insurance plan. Contact USF s Student Health Services at insurance@shs.usf.edu for costs and sign-up. Scholars employed by USF who plan to enroll in an employee insurance plan, must purchase the USF plan to cover the period between the begin date on the DS-2019 and the date employee insurance begins. Scholars are also required to purchase additional coverage to cover medical evacuation and repatriation. Instructions to USF Sponsoring Department: This form should be submitted three - four months prior to the planned start date at USF to ensure that the exchange visitor will have adequate time to apply for the visa and arrange travel. The program begin and end dates on this request should correspond to the dates that the academic activity will take place and should match the period covered in any letter of appointment, offer letter or letter of support. Please provide a copy of this letter with the request. Scholars may arrive up to 30 days prior to the program start date to move in and settle into their new environment. They also have 30 days after the program end date to settle their affairs. The department is required to verify that the exchange visitor s academic credentials are appropriate to the proposed program objectives. Please provide OIS with a copy of the CV and proof of degree completion. If the scholar will bring a spouse and/or dependent children (unmarried and under 21 years of age) to live with them, the appropriate sections of this form should be completed. These dependents will apply for J-dependent visas and will be required to have health insurance FOR THE DURATION OF THE SCHOLAR S PROGRAM. If the dependents will visit the scholar, they should apply for visitor visas or use the visa waiver program. Department Responsibilities: Supervise the academic activity during the scholar s stay at USF. Arrange for office space and access to equipment (computer, phone, etc.) as deemed appropriate for the proposed academic activity. Assist OIS with the collection of immigration documentation and proof of health insurance. Contact OIS before changes are made to the scholar s program and to inform OIS when the scholar leaves. 1 of 9

Step-by-Step Application Process: 1. Submit this form three - four months prior to the planned start date at USF. 2. Complete ALL sections leaving no blanks. If the scholar is not bringing dependents to live with them, put NONE in the dependent box. 3. Verify English language proficiency using the English Proficiency Verification Form. 4. If the scholar is a medical doctor (physician), complete the Alien Physician Form to certify no patient care. 5. The faculty sponsor, the department chair, and the college dean must sign the form. If the department chair and college dean are the same person, that person must sign in both places. Signatories must be USF employees as listed in USF s HR database. Forms from USF Health must also include the signature of the appropriate USF Health Vice President. 6. USF Export Control must review and sign prior to submission to OIS. 7. With the completed form, submit the following support materials: a. Copies of scholar s biographical page of passport (this must include expiration date, and birth date) b. Proof of funding can include any combination of the following: i. Scholarship letter, OR ii. Funding letter from home institution, OR iii. USF offer letter, OR iv. Other funding documents clearly showing sponsor, amount, and scholar s name, OR v. Personal or family bank statement. c. Scholar s CV or detailed resume d. Proof of Scholar s highest degree level. (copy of diploma or transcripts translated into English) e. If exchange visitor is currently inside the US or has previous J-1 status, please also include: i. Current visa stamp in passport ii. I-94 (front and back of white card stapled into passport or electronic I-94 printed from CBP website) iii. DS-2019 Form from current/past institution. f. Copy of the invitation letter. g. If dependents will live with the scholar, include the biographical page of each dependent s passport. 8. OIS will review the form for completeness. If there are blanks or missing information, the entire packet will be sent back to the department for corrections. 9. If the form is complete, OIS will issue the DS-2019(s) within 10 business days of receiving the request form and support materials. 10. OIS notifies the department to pick up the DS-2019 to send to the scholar via express mail. This packet is sealed and should not be opened by the department. The department may send additional departmental materials to the scholar with the sealed packet. Scholar Pre and Post Arrival: 1. Obtaining J-1 status outside the US: a. The scholar pays the SEVIS I-901 fee (https://www.fmjfee.com/) and applies for a J-1 visa at a US Embassy or Consulate. b. The consulate officer approves the J-1 visa and the scholar makes travel plans to arrive in Florida. The scholar and dependents may enter the US up to thirty days before program start date on the DS-2019. 2. Obtaining J-1 status inside the US: a. OIS contacts current J-1 program sponsor to arrange transfer of the scholar s J-1 SEVIS record to USF. b. The scholar s category, subject/field code, and program objective cannot change. c. USF will not have access to the SEVIS record to produce the final DS-2019 until the scholar arrives at USF. 3. Housing/Accommodations: a. OIS does not place scholars into housing. Departments should assist scholars with finding accommodation. b. On-campus housing resources include: i. Visiting scholar apartments - http://www.usf.edu/student-affairs/housing/housing-options/visiting-scholars.aspx ii. Summer Conference Housing - http://www.usf.edu/student-affairs/housing/housing-options/conferencehousing.aspx c. Off-campus housing resources include: i. USF Affiliated Properties - http://www.usf.edu/student-affairs/housing/resources/affiliated-properties.aspx ii. Short-term Stay Properties - http://www.usf.edu/student-affairs/conferences-special-events/housing/offcampus.aspx iii. USF Off Campus Partners - https://offcampushousing.usf.edu/ iv. Non-USF website that offer USF discounts - http://www.myidealplace.com/accounts/usftmp/ 4. Airport Pick Up Resources: a. Tampa International Airport Ground Transportation - http://www.tampaairport.com/ground-transportation b. USF s Friends of Internationals free airport pickup - http://www.usfinternationals.org/index.php/airport-rides 5. Scholars are notified via email to begin their istart process to upload documents before arrival and of the requirement to complete Document Check and Mandatory Orientation after arrival to USF. a. During Document Check, OIS will activate their SEVIS record. b. Two days (48 hours) after SEVIS activation, the Scholar can apply for an SSN number at the local SSA office. c. OIS conducts Scholar Orientation once per month. Scholars are required to attend the next available session. 6. Scholars are assigned a U Number and create a USF Net ID during the document creation process. This allows the department to provide the scholar with access to internal computer systems, shared files, keys, USF email, and library services. 2 of 9

To be completed by the sponsoring USF Department. Submit form with supporting materials to OIS at USF mail point CGS101 or bring to office location CGS 104. ALL FIELDS MUST BE COMPLETED OR APPLICATION WILL BE RETURNED Purpose of this Request: J-1 entry to the U.S. from abroad Change of Status to J-1 J-1 transferring to USF from another U.S. institution SEVIS ID (required): N Name of J-1 Advisor: Phone # of J-1 Advisor: Email of J-1 Advisor: Field: (same as previous DS-2019) Proposed Category at USF: Research Scholar/ Post-Doc Professor Short-term Scholar (up to 6 months only, no extensions) Specialist REQUESTED PROGRAM DATES: (As seen on invitation letter) From: To: mm/dd/year mm/dd/year Scholar Biographical Data: (All biographical information must match passport information) Family/Last Name: Middle Name: Date of Birth (MM/DD/Year): Country of Birth: Country of Permanent Residence: First Name: Gender: Place/City of Birth: Country of Citizenship: Email Address: Phone Number: Address in Home Country: Occupation in home country (i.e. student, professor, researcher, etc.): Highest academic degree: (Note: Scholar must provide current CV/Resume and Proof of Highest Degree with English translation) DETAILS OF PROPOSED ACADEMIC ACTIVITY: (attach separate sheet if necessary) USF position title (put visiting if no appointment): Postdoctoral scholars must be paid according to university guidelines at http://www.grad.usf.edu/adminandpi.asp Field/Subject Code (i.e. Electrical Engineering, Biotechnology): Description of activity: (include names of USF research partners, subject and/or purpose of research/teaching): Site of activity: (list all physical addresses where scholar will perform activity - must be complete addresses with dept. name, room number): Has the scholar ever applied or been to USF before? Yes No If yes, provide U# Has the scholar held J-1 or J-2 immigration status at any institution? Yes No If yes, submit copies of all previous DS-2019 s. Will spouse or dependent children under the age of 21 years old come to USF to live with the scholar? Yes No If yes, complete the Dependent Information page of the application. 3 of 9

SOURCE OF FUNDING FOR SCHOLAR (and any dependents): Scholars must submit proof of adequate liquid funds in US Dollars for the duration of their stay at USF. Current estimated expenses for one year (housing, meals, transport, personal) - $21,588/year ($1,799/month) plus $ 5,000/year per dependent. Acceptable proof includes USF offer letters, home institution funding letters, government sponsorship letters or personal/family bank statements. Proof must include the scholar s name, total amount, and reference the visit. Below list total amounts available in US Dollars for the requested dates of the visit. USF -- Amount: Funds provided by (college/dept.): if checked must include USF offer or sponsorship letter. US Government Agency (direct award) -- Amount: Source: [name of agency] Exchange Visitor s home government -- Amount: A Bi-national Commission of the visitor s country -- Amount of funding: Other organizations -- Amount: Source [name of organization] Personal Funds -- Amount: Verified by submitting bank certification or letter indication availability of funds. Scholar Health Insurance Verification: According to Federal Regulation 22 CFR 62.14, J scholars and their dependents must have insurance in effect during the ENTIRE period of participation. The insurance must have minimum levels of coverage that provide: a) Medical benefits of at least US$100,000 per accident/illness; b) Repatriation of remains for US$25,000; c) Medical evacuation for US$50,000; d) A deductible not to exceed US$500 per accident or illness. SCHOLAR ATTESTATION: I understand that I must have health insurance coverage as stated above for myself and dependents in effect on or before the start date of my DS-2019. Furthermore, I understand that proof of compliance is required to begin my program at USF. Therefore, I must bring proof of insurance under a qualifying USF insurance plan or a completed J-1 Scholar Alternative Insurance Compliance Form to OIS when I check-in. Failure to provide proof of insurance may result in the inability to participate in the planned program. Scholar Signature: Date Export Control Certification: This section must be signed by the USF Office of Export Controls BEFORE submitting the Request to OIS. Forward a scanned copy of this form with all accompanying documents to exportcontrol@usf.edu for review and certification. Export Control Officer Signature Export Control Officer Name Date VERIFICATION OF USF DEPARTMENT SPONSORSHIP: Signatories must be USF employees as listed in USF s HR database. If the department chair and college dean are the same person, that person must sign in both places. Forms from USF Health or USFSM must also include the signature of the appropriate Vice President. Signatories attest that as the department sponsors of this scholar, the information included in this application is correct to the best of their knowledge. Sponsoring Faculty Legal Name: Title: Phone: Email: Campus Mail point: Faculty Signature: Date: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: Print Name of Department Chair/Head: Signature of approval Department Chair: Date: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: Print Name of College Dean or VP or their designee: Signature of approval Dean or VP or their designee: Date: If scholar is hosted at USF Health or USFSM, additional Signature of Approval Required from USF Health VP OR VP Academic & Student Affairs USFSM VP Printed Name: Signature of Approval: Date: Sealed DS-2019 packets are picked up by the department to send to the scholar by Express Mail. Enter the name of the department staff that should be contacted: Contact name: Phone Email 4 of 9

MEDICAL DOCTORS (ALIEN PHYSICIANS) in Non-Clinical Program: If the scholar is a medical doctor or alien physician, this section must be completed. For graduate medical training or clinical care at USF, please contact Graduate Medical Education at 813-974-478 for information regarding ECFMG program. USF OIS is authorized to issue DS-2019 s for non-clinical programs only. For the visit to qualify as a non-clinical program at an academic institution, the academic activity must be predominantly related to observation, consultation, teaching, or research with no element of patient contact or only incidental patient contact. The department chair must check and sign below to indicate which option applies. Per 22 CFR 62.27(c), a copy will be attached to the DS-2019. PLEASE CHECK ONE OF THE FOLLOWING AS APPLICABLE: A. NO PATIENT CARE This certifies that the program in which (name of scholar) is to be engaged is solely for the purpose of observation, consultation, teaching, or research and that no element of patient care services is involved. USF DEPT. CHAIR Printed Name: Department: Signature: Date:... If no patient care listed above, RO/ARO Certification: This certifies that the program in which the above named physician is to be engaged is solely for the purpose of observation, consultation, teaching, or research and that no element of patient care services is involved. Printed Name: Signature: Date: ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ B. INCIDENTAL PATIENT CARE 1. The program in which (name of scholar) will participate is predominantly involved with observation consultation, teaching, or research; 2. Any incidental patient contact involving the alien physician will be under the direct supervision of a physician who is a U.S. citizen or resident alien and who is licensed to practice medicine in the state of Florida; 3. The alien physician will not be given final responsibility for the diagnosis and treatment of patients; 4. Any activities of the alien physician will conform fully with state licensing requirements and regulations for medical and health care professionals in the state of Florida; and 5. Any experience gained in this program will not be creditable toward any clinical requirements for medical specialty board certification. USF DEPT. CHAIR Printed Name: Department: Signature: Date:... Dean of the College of Medicine (or their designee) Printed Name: Signature: Date: 5 of 9

Dependent Information (optional) If the spouse or dependent children plan to visit for a short time or several short visits during the scholar s program, do not complete this section. They can come to the US using visitor visas and our office would not need proof of insurance. Scholars should complete this section to request DS-2019 s for spouse or dependent children only if they will live with them in the US during the dates of activity at USF. Scholar will be required to purchase health insurance that meets the federal minimums listed in the health insurance section for the dates listed on the scholar s DS-2019 for the dependents. The dependent s legal status in the US requires this insurance. Failure to purchase insurance will result in the cancellation or termination of the DS-2019. If the dependent will not join the scholar immediately, DS-2019s can be requested after the scholar arrives and dependent health insurance would begin at their arrival in the US. If this section is completed, submit a copy of the biographical page of the passport for each dependent. Spouse Biographical Data: Spouse Last Name: Place/City of Birth: Country of Permanent Residence: Date of Birth (MM/DD/Year): Email Address: First/Middle Name: Country of Birth: Country of Citizenship: Gender: Phone Number: Address in Home Country: Dependent Child 1 Biographical Data: Child Last Name: Place/City of Birth: Country of Permanent Residence: Date of Birth (MM/DD/Year): Email Address: First/Middle Name: Country of Birth: Country of Citizenship: Gender: Phone Number: Address in Home Country: Dependent Child 2 Biographical Data: Child Last Name: Place/City of Birth: Country of Permanent Residence: Date of Birth (MM/DD/Year): Email Address: First/Middle Name: Country of Birth: Country of Citizenship: Gender: Phone Number: Address in Home Country: Use additional paper for additional dependent children 6 of 9

University of South Florida Office of International Services J-1 Scholar English Proficiency Verification - Assessment Interview Parameters and Protocol Research Scholars, Short Term Scholars, Professors, and Specialists Federal regulations 22 C.F.R.62.10(a)(2) require prospective J-1 exchange visitors to possess sufficient proficiency in the English language to participate in his or her program and to function on a day-to-day basis. OIS must retain evidence of how English proficiency was measured and make this available to the Department of State upon request. The host department must verify the prospective J-1 scholar s English language ability and submit applicable documentation with the Scholar Request. Scholar s Last/Family Name: First Name: Date of birth Country of citizenship J-1 Category: Length of Visit to USF: Please choose one of the assessments below: The scholar is a native speaker of English, from a country whose official language is English. (per USF Admissions List - http://www.usf.edu/admissions/international/admission-information/graduate/requirements-and-deadlines.aspx ) The scholar graduated from a degree program taught primarily in English. NOTE: If the school is not located in a country where English is the official language per USF Admissions, the documentation must show that the program was delivered in English. Attach a copy of the diploma or transcript. The scholar submitted a letter from an academic institution or English school that verifies by the school/teacher that he or she can speak and understand English well enough to function on a day to day basis in an English-speaking environment. Attach a copy of the letter. The scholar submitted one of the following test scores meeting the minimums listed here. Check one and attach a copy of the test score. TOEFL ibt 79 (with a minimum of 23 on the speaking section). IELTS 6.0 (with a minimum of 5.5 on the speaking section). PTE 53 (with a minimum of 45 on the speaking skill and oral enabling skills). Documented interview either in person or by videoconferencing, or by telephone if videoconferencing is not a viable option. Interview must follow parameters and protocol listed below and use OIS English Comprehension & Speaking Assessment Interview Score Sheet. Department Interview Parameters and Protocol 1. Plan to spend at least 25 minutes for the interview and assessment. 2. At least two USF employees must conduct the interviews. At least one must have no direct connection with the scholar, the scholar s planned activity at USF, or the scholar s sponsor. Interviewers must use the Score Sheet from OIS. 3. The interview consists of four parts. All four parts must be used. The Score Sheet has suggested questions for each part. If different questions are used, they must be included on the back of the Score Sheet. 4. Candidates may be given a range of prompts to elicit a variety of discourse types (e.g. narratives for clarity of sequencing of events; opinions and ideas about the future for ability to use the language of speculation; processes and concepts from her/his field of study for the ability to explain clearly, etc.). 5. The interviewers should feel free to prompt and/or explain where necessary; the interview should be an opportunity for the candidate to show what they know rather than be blocked by what they do not know. Follow-up questions can be asked where possible (e.g. Tell us more about that. Can you give us more examples/details? etc.) 6. Scoring Use the TOEFL ibt Independent Speaking rubric - https://www.ets.org/s/toefl/pdf/toefl_speaking_rubrics.pdf. To fully engage in activities at USF, a minimum grade of 3 is required in all parts of the test. Note answers and scoring on the Score Sheet provided. 7 of 9

University of South Florida Office of International Services English Comprehension & Speaking Assessment Interview Score Sheet Scholar Printed Name: Interviewer One Printed Name: Department: Interviewer Two Printed Name: Department: Part 1 - Easing the candidate into the interview by asking about what s/he knows well. (c 5 mins) Describe where you come from. What is your town/city like? Tell us about something interesting that happened in your city/country recently, like a current event or a festival. If we had a chance to visit your city or country, what sights would you recommend that we see? Why? Part 2 - Giving the candidate an opportunity to talk about field of study. (Content-specific and precise questions.) (c 10 minutes) What are you currently doing research on? Tell us about how you conduct your research. Tell us about an innovation or development in your field. Part 3 - Inviting the candidate to speculate (c 5 minutes) What skills and knowledge do you expect to gain from your time here at USF? What are your plans for after your visit with us? How might your life and/or work change? What plans do you have for sharing your learning with others when you return to your country? Part 4 - Inviting the candidate to ask questions (gives insight into the candidate s comfort in initiating talk) (c 5 minutes) Are there any questions you would like to ask us about Tampa, the university, the department, etc.? As interviewer, I confirm that I have made a good faith effort to assess the English proficiency of this scholar during this interview using the USF protocol and parameters. Based on my assessment this scholar (check one) can cannot function on a day-to-day basis in an English-speaking environment in the US. Interviewer ONE - Full Name: Date Position at USF: Signature 8 of 9

University of South Florida Office of International Services English Comprehension & Speaking Assessment Interview Score Sheet Scholar Printed Name: Interviewer One Printed Name: Department: Interviewer Two Printed Name: Department: Part 1 - Easing the candidate into the interview by asking about what s/he knows well. (c 5 mins) Describe where you come from. What is your town/city like? Tell us about something interesting that happened in your city/country recently, like a current event or a festival. If we had a chance to visit your city or country, what sights would you recommend that we see? Why? Part 2 - Giving the candidate an opportunity to talk about field of study. (Content-specific and precise questions.) (c 10 minutes) What are you currently doing research on? Tell us about how you conduct your research. Tell us about an innovation or development in your field. Part 3 - Inviting the candidate to speculate (c 5 minutes) What skills and knowledge do you expect to gain from your time here at USF? What are your plans for after your visit with us? How might your life and/or work change? What plans do you have for sharing your learning with others when you return to your country? Part 4 - Inviting the candidate to ask questions (gives insight into the candidate s comfort in initiating talk) (c 5 minutes) Are there any questions you would like to ask us about Tampa, the university, the department, etc.? As interviewer, I confirm that I have made a good faith effort to assess the English proficiency of this scholar during this interview using the USF protocol and parameters. Based on my assessment this scholar (check one) can cannot function on a day-to-day basis in an English-speaking environment in the US. Interviewer TWO - Full Name: Date Position at USF: Signature 9 of 9