J-1 Exchange Visitor – Completion of Program Form
(Submitted to ISSS by J1 Coordinator)
22 C.F.R. § 62.10(d) Monitoring of exchange visitors. Exchange visitors’ participation in their exchange
program must be monitored by employees of the sponsor. Sponsors must: (1) Ensure that the activities
in which exchange visitors are engaged are consistent with the category and activity listed on their
Forms DS–2019.
Sponsors are required to include general examples of EV cross-cultural activities in annual report.
TO BE COMPLETED BY THE SCHOLAR (EXCHANGE VISITOR):
Name: _______________________________AU ID#: ____________ E-mail: ___________________________
Appointment Dates: ______________________ EV Category: ______________ Department: _______________
Outcome of EV Participation: □Submitted Paper/ Report
□ Presented seminar/talks
□Published articles
□ Co-published chapter/book/article with AU faculty
□ Other _____________
________________________________________________________________
Cross-Cultural Activities that you participated in during your stay (any formal or informal activities between you
(and/or dependents) and Americans which you feel increased understanding of each other’s society, culture, and
institutions, at AU or outside AU) – please be specific:
___________________________________________________________________________________________
___________________________________________________________________________________________
Signature of EV: _________________________________ Date: ________________
TO BE COMPLETED BY AU HOST FACULTY:
Please select one:
 This is to certify that the scholar was engaged in the activities listed for the J1 EV category and has
completed the program as expected on the date listed on the DS-2019.
 This is to certify that scholar was engaged in the activities listed for the J1 EV category and
completed the program on ___________, which is earlier than the original end date listed on DS-2019.
___________________________________
___________________
Name of AU Host Faculty
__________
Signature
___________________________________
___________________
Name of J1 Coordinator
___________
Date
__________
Signature
Phone
___________
Date
TO BE COMPLETED BY ISSS:
Received by and placed in J1 Box_________________________ __________________
Name of RO/ARO
Signature
Updated ISSIS (& SEVIS if applicable): ______________________
Phone
_________
Date
_______
RO/ARO signature
Date
International Student and Scholar Services · Butler Pavilion 410 · 4400 Massachusetts Ave., NW · Washington, DC 20016
Phone: 202-885-3350 · Fax: 202-885-3354 · E-mail: J1EV@american.edu · Website: www.american.edu/ocl/isss/
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