International Education & Engagement
1209 Centennial Hall; 1725 State Street
La Crosse, WI 54601 USA
Tel: +1 (608) 785-8016
Fax: +1 (608) 785-8923
international@uwlax.edu
www.uwlax.edu/iee/
J-1 Scholar Initial DS-2019 Request Form
To be completed by the Visitor
The following documents must accompany this form:
 Current Curriculum Vitae
 Copy of official diplomas with English translation as necessary
 If research scholar not employed through UWL, prepare a document listing the title and description of the research you
will be conducting and a description of goals you hope to accomplish during your exchange visitor program
A. Scholar Information
Last (family) Name: _______________________________________________ (as it appears on your passport)
First Name: ______________________ Middle Name: ______________ Date of Birth: _______________________
Email Address: _____________________________________
Male
Female
Mailing Address:
_________________________________________________________________________________________________
Phone #: ______________________________
City of Birth: ________________________________________
Province of Birth: _____________________________ Country of Birth: _____________________________________
Country of Permanent Residence: __________________________ Country of Citizenship: _______________________
Current Position in Home Country – job title: _____________________________________________________________
Name of Employer/University in Home Country where applicant works/studies:
__________________________________________________________________________________________________
Applicant’s current employer in Country of Permanent Residence is:
Private
Local Government
State/Regional Government
Central Government
Highest Degree Earned to Date: _____________________ Field of Study on Diploma: ___________________________
Have you applied for US Permanent Residence (a green card)? Yes
No
Have you been in J-1 or J-2 status sometime within the past 5 years?
No
Yes* – when: ___________________________________
Start
Category: ______________________________
End
If Yes, provide copies of all previous DS-2019s with this application along with most recent copy of I-94 online record.
Note: If you have visited the U.S. on J-1 Research Scholar or Professor category within the last 2 years, a new Research
Scholar program may not be possible.
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B. Funding Requirements: Minimum* funding requirements are:

J-1 living expenses
$16,800/year ($1400/month)
*The minimum funding does not include airfare, healthcare costs not covered by insurance, school tuition/fees,
travel/transportation within the U.S., clothing, etc. The scholar is advised to prepare additional money to cover unexpected
expenses that may occur while in the U.S.
All J-1 applicants must be able to document a minimum of $16,800 per year to be used to cover basic living expenses
while pursuing their J program in the U.S. Additional financial documentation is required for dependents. Acceptable
financial documents are as follows:
1. Signed Letter of Appointment including salary information if scholar will be paid through UWL
2. Bank Statement in Scholar’s Name
 Most recent 3 months in English of recent bank statements (per account) on bank letterhead signed by
bank official
 Must demonstrate that funds would be readily available to meet scholar’s expenses plus that of any
dependents and are easily accessible to the scholar
3. Bank Statements in Sponsor’s Name and Letter of Support
 Most recent 3 months in English of recent bank statements (per account) on bank letterhead
 Sponsor must write a letter explaining relation to J-1 Scholar and declaring support for J-1 while s/he is
participating in a J program in the U.S.
4. Scholarship from a Government
 IEE must receive a clear copy of the formal award letter from the government
 Letter should clearly state stipend/salary and any covered expenses, including living expenses, health
insurance, etc.
 Must be dated within 3 months
 Must indicate that J-1 will be participating in an Exchange Program at UWL
5. Funding from Scholar’s Home University
 Letter from the institution stating amount and terms of stipend/salary on university letterhead and signed
by a University Official indicating that scholar will be participating in an Exchange Program at UWL
C. Submission Process:
Prepare and submit the following form/supporting documentation directly to your host department/supervising faculty:
1. Completed J-1 Scholar Initial DS-2019 Request form
2. Copy of identity page of a valid passport for J-1 applicant
3. Current curriculum vitae
4. Copies of diplomas (institutions of higher education) translated into English
5. If research scholar, title and description of research project and description of goals you hope to accomplish
during your exchange program
6. Proof of permanent residency if applicant is a citizen of one country but legal permanent resident of another
7. Proof of funding as outlined in Part B
8. Copies of all previous DS-2019s (either as J-1 of J-2) for the past 5 years
9. Copy of most recent I-94 record if submitting a previous DS-2019
10. Signed Scholar Agreement Form (part D - located below)
Submit all documents listed above directly to your host department 3 to 4 months prior to your proposed
program start date. Your host department will submit your application/documentation along with their
required documents to IEE. Upon receipt of a complete application, including all required documents, IEE will
process the DS-2019 request within three weeks and the supervising faculty will be contacted via email once
your form DS-2019 has been created.
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International Education & Engagement
1209 Centennial Hall; 1725 State Street
La Crosse, WI 54601 USA
Tel: +1 (608) 785-8016
Fax: +1 (608) 785-8923
international@uwlax.edu
www.uwlax.edu/iee/
D. Scholar Agreement Form
I understand that the US Department of State mandates that I have sufficient health insurance for the entire
period of my J-1 status in the United States. I also understand, that as a J-1 scholar at the University of
Wisconsin La Crosse (UWL), I am required to purchase coverage through UWL’s International Scholar plan for
myself. I also understand that I am responsible for paying all costs associated with this insurance, including all
medical/dental bills not covered by insurance. I am also responsible for maintaining coverage for the duration of
my J-1 status in the U.S. Federal regulations require UWL to terminate your J-1 program if:
 You fail to obtain or maintain health insurance as set forth above
 You misrepresent your insurance coverage; and/or
Minimum insurance coverage for all J visa holders per U.S. Department of State Regulations (22
CF62.14)





Medical benefits of at least $100,000 per accident or illness;
Repatriation of remains in the amount of $25,000
Expenses associated with the medical evacuation of the exchange visitor to his or her home country in
the amount of $50,000
A deductible not to exceed $500 per accident or illness.
An acceptable insurance policy may require a reasonable waiting period for pre-existing conditions. It
may also include provisions for co-insurance payments of up to 25%. It may not unreasonably exclude
coverage for perils inherent to the activities of the exchange program. Any insurance policy must be
underwritten by an insurance corporation having an A.M. Best rating of "A-" or above, and Insurance
Solvency International Ltd. rating of "A-I" or above, a Standard & Poor's Claims-Paying Ability rating
of "A-" or above, or a Weiss Research Inc. rating of "B+" or above. Insurance backed by the full faith
and credit of the Exchange Visitor's home government, insurance that is part of a group health benefits
program offered to employees or enrolled students by the University, and insurance that is underwritten
by a federally qualified HMO or CMP do not require a rating.
University of Wisconsin La Crosse J-1 Scholar Insurance Requirements
UWL requires all J-1 visa holders to purchase UWL’s International Scholar Health Insurance. This coverage is
greater than that required by 22 CF 62.14. UWL uses Student Assurance Services (SAS) to provide coverage
http://www.sas-mn.com/. For additional information, visit http://www.uwlax.edu/InternationalEducation/Health-insurance/
Once the host department/supervising faculty provides arrival information to IEE, an email will be sent to the
scholar explaining how to enroll in the insurance plan. Information on how to use the insurance will be included
in the mandatory J-1 scholar orientation session provided by International Education & Engagement Office.
Scholars do not have access to UWL’s Student Health Center.
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TWO-YEAR HOME RESIDENCY REQUIREMENT
Depending upon your funding and skills, you may become subject to the Two Year Home Residency
Requirement by entering the U.S. in J-1 status. This means that you may be required to spend at least two years
in your home country before coming back to the U.S. to work in H1-B or L status. You would not be eligible to
receive a green card until you have spent two years back home and you would not be eligible to change your
status in the U.S. to another non-immigrant status. Some Exchange Visitors may be granted a waiver for the
Two Year Home Residency, but this is timely and costly. For waiver information visit
http://travel.state.gov/content/visas/english/study-exchange/student/residency-waiver.html
12 MONTH BAR
An individual is not eligible to begin an exchange program as a Professor or Research Scholar based on a DS2019 issued to begin a new program” if she/he was physically present in any J status (including J-2 status) for
“all of part of” the “twelve month period immediately preceding the program start date of program on his/her
form DS-2019. This bar has 3 exceptions: J-1 transfers, time spent as a J-1 short-term scholar, and prior
physical presence in J status which was of less than 6 months duration.
24 MONTH BAR
An individual who participates in the J Exchange Visitor Program as a Professor or Research Scholar becomes
subject to a Two-Year Bar on “repeat participation” in those particular categories after participating in his or her
program for any length of time (one day to five years). The U.S. State Department of State has taken the
position that the Two-Year Bar will also apply to J-2 dependents of the J-1 Professors or Research Scholars if
the J-2 subsequently wishes to return as a J-1 Professor or Research Scholar. This is a separate requirement
from the Two Year Home Residency Requirement.
EMPLOYED BY UWL
I understand if I am not receiving payment through UWL as an employee during my J program, I will not receive any
faculty and/or staff benefits nor will I be able to represent myself as an employee of UWL. In this situation, I will be
considered a Courtesy Scholar for UWL purposes.
By signing this form, you agree to comply with The University of Wisconsin La Crosse policy and United
States State Department regulations pertaining to J-1 Scholars.
Name of J-1 Applicant: _________________________________________________________________
Signature of J-1 Applicant: ______________________________________________________________
Date: ________________________________
Location: ___________________________________
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