U.S. Forest Service International Programs
Host Application and Data Sheet
(Fields will expand as you type)
SERVICES REQUESTED:
DS-2019 for J-1 visa
Insurance
Debit Card
EXCHANGE VISITOR’S INFORMATION:
FAMILY NAME/SURNAME:
FIRST NAME(S):
MIDDLE NAME(S):
DATE OF BIRTH:
Select Month
,
Is the data on the Exchange Visitor’s Application accurate to the best of your knowledge?
YES
NO
I have approved this Exchange Visitor to bring a spouse and/or children as J-2 dependents on this program.
YES
NO
Number of Dependents:
If yes, please attach copies of passport biographical data page(s) for each accompanying dependent.
HOST INFORMATION:
POINT OF CONTACT AT HOST SITE:
CELLULAR NUMBER:
TITLE:
UNIT/DISTRICT:
FACSIMILE (FAX) NUMBER:
OFFICE PHONE NUMBER:
E-MAIL ADDRESS:
ADDITIONAL/EMERGENCY CONTACT
NAME IN HOST UNIT OR COMMUNITY:
PHONE NUMBER:
RELATIONSHIP:
EMAIL:
SITE OF ACTIVITY:
Street Address:
Building/Room Number:
City:
State:
Zip Code:
ADDRESS:
Street Address:
Building/Room Number:
City:
State:
Zip Code:
PROGRAM DESCRIPTION:
Program Status:
New Activity/Visitor
Amendment
If an amendment or extension please explain:
Extension
OFFICIAL PROGRAM DATES: (Month DD, YYYY)
Start Date: Select Month
,
End Date Select Month
,
SUBJECT OF ACTIVITY/PROGRAM:
VISITOR’S FIELD OF SPECIALIZATION:
DESCRIPTION OF ACTIVITY/PROGRAM:
DESCRIPTION OF PROPOSED CROSS-CULTURAL ACTIVITIES:
PROPOSED J-1 CATEGORY:
GOVERNMENT VISITOR
No minimum stay
18-month maximum stay
RESEARCH SCHOLAR
3-week minimum stay
60-month maximum stay
Subject to 24-month bar from repeat participation
SHORT-TERM SCHOLAR
No minimum stay
6-month maximum stay
No extensions
SPECIALIST
3-week minimum stay
12-month maximum stay
No extensions
CATEGORIES WITH SPECIALI REQUIREMENTS
Must submit form DS-7002 Training Plan
Consult with IVP Specialist for eligibility requirements
Trainee
3-week minimum stay
18-month maximum stay
No extensions
Subject to 24-month bar from repeat participation
Intern
3-week minimum stay
12-month maximum stay
No extensions
Please note that all Forest Service sponsored J-1 participants are subject to section 212-(e) two-year home residency requirement before becoming
eligible for U.S. Permanent Residency, H-1B and L-1 status. For more information about the J-1 categories please consult with an IVP Specialist.
Does the Exchange Visitor have adequate English Language skills for this program?
YES
NO
Please describe how English Language proficiency was evaluated:
FUNDING SOURCE(S):
PLEASE CHECK ALL THAT ARE APPLICABLE:
Host Unit (excluding room and board)
Total Amount Provided:
USD
Visitor’s Home Government
Total Amount Provided:
USD
Visitor’s School or Employer
Please specify sponsor:
Total Amount Provided:
USD
Other 3rd Party Sponsor or Organization
Please specify sponsor:
Total Amount Provided:
USD
Personal Funds
Total Amount Provided:
USD
TOTAL FUNDS AVAILABLE:
USD
If Exchange Visitor’s program is being sponsored by the Host please fill out the following information; otherwise, please refer to the instruction sheet
for acceptable proof of funding documents.
FUNDING PROVIDED BY HOST:
Total Incl.
TYPE
AMOUNT/
DESCRIPTION
15%
JOB CODE(S) and OVERRIDE(S)
Check and complete all that apply:
VALUE
Overhead
Allowance - Single Disbursement
Number of Months:
Monthly Stipend/Maintenance
Allowance
Select Insurance
Health Insurance
Housing (In-Kind)
Field Unit Bunkhouse
Other accommodation provided
by host
MAILING INSTRUCTIONS FOR DS-2019 AND PRE-ARRIVAL PACKAGE:
(This section must be completed in order for the application to be processed)
Documents will be sent to the visitor’s home address, as specified on the Visitor Application
Select Accout Type Account Number:
Billing Zip Code:
ADDITIONAL COMMENTS OR SPECIAL INSTRUCTIONS:
UNIT CERTIFICATION:

In compliance with all Federal regulations governing the J-1 Exchange Visitor Program, I certify that all information given on this form is
true and accurate to the best of my knowledge

My signature indicates that I have read, understand and agree to abide by the Unit Responsibilities outlined in the US Forest Service J-1
Exchange Visitor Program guidelines

I agree to fulfill all responsibilities related to supporting and monitoring the exchange visitor before, during and after the program described
in this application

I authorize International Programs to charge expenses and fees related to this program to the accounts outlines above
Host Advisor:
Funds Authorized by:
Name:
Name:
Title:
Title:
Signature: ___________________________
Signature: ___________________________
Date:________
Date:________