J-1 Scholar Initial Request Form
Office of International Education
717 Chapin St. / Beloit, WI 53511
608-363-2269 / http://www.beloit.edu/~oie/
This form is to be completed by the department or faculty host inviting an international scholar to come to
Beloit College as a visiting professor, short-term professor, or specialist. This is not an immigration
document. Do not send this document to a prospective visitor as it will not enable him/her to obtain a
visa. All questions below must be answered in full to avoid delays in processing the DS-2019, which will
enable the scholar to apply for a J-1 Exchange Visitor visa. Please type or print.
Required Information:
Name of person exactly as it is written on his/her passport (ask the visitor to fax a copy of his/her passport
photo page to you):
_____________________________________________________ Gender: [ ] Male [ ] Female
Family Name (Last)
Given (First)
Middle
Date of Birth ____________________ Place of Birth ___________________________________
(Mo/Day/Year)
(City)
(Country)
Country of Citizenship: ________________________
Country of Legal Permanent Residence: ________________________
Visitor’s Email and Fax Number (if available): ________________________________________
Professional Position in Home Country: ______________________________________________
Is the employer [ ] Educational [ ] Private Sector [ ] Government [ ] Other_______________
Beloit College Position & Title (Semester and AY appointments only):___________________________
Physical Address of On-campus Location: ____________________________________________
Physical Address of any Off-campus Work Location: ___________________________________
Subject/Field of Visitor’s Primary Activity or Specialization at Beloit College. (Examples: Short-term
Lecturer, Performer, etc.):_____________________________________________________
Does the International Visitor have a Ph.D.? [ ] Yes [ ] No*
*If no, please note that all J-1 scholars are expected to hold advanced degrees and be well established in their discipline.
(International graduate students should not be appointed to academic positions.) If the responsibility of the appointing academic
department to determine the appropriate academic title and to ensure that the visitor meets all educational requirements for that title
before the DS-2019 request form is returned to OIE. Any exceptions to these guidelines should be approved in advance by the Dean
of the College. This approval should accompany the DS-2019 request form.
Is the International Visitor a Ph.D. candidate? [ ] Yes [ ] No
Has the visitor been in J-1 scholar status in the last 12 months? [ ] Yes* [ ] No
*If yes, please provide copies of the visitor’s previous IAP-66/DS-2019 forms.
Length of Visit / Academic Appointment: Start date __________ End date ___________
The academic appointment at Beloit College must be for the entire period listed above. Financial support information must be for
this period. The total time allowed in the U.S. in J-1 status is 3 years. Extensions beyond 3 years are possible only for exceptional
circumstances.
Note Regarding Start Date
J-1 scholars must enter the U.S. and report to Beloit College no more than 30 days before and NO More than 30 days after the start
date on the DS-2019. Please contact us if a scholar’s plans change and s/he will not arrive in time.
Source(s) and Amount of Financial Support for Visitor’s Entire Stay
The U.S. government requires that Beloit College 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 the minimum funding guidelines and are covered by medical insurance. Please note that
medical insurance is a U.S. Government requirement.
Minimum Funding Requirements for Short Term Scholars (Amounts are for the duration of the
scholar’s visit). (*)(**)(***)
$__________ Beloit College
$__________ Intl. Org. (source) _____________________________
$__________ U.S. Govt. Agency (source)** ___________________
$__________ J-1 Scholar’s Government
$__________ All other organizations (source)___________________
$__________ Personal funds
*This funding may come from any source including the visitor’s personal savings or Beloit College salary. These amounts represent
the bare minimum and do not include the cost of health insurance coverage, which could range from $60-200 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 Beloit College professor,
department, or grant, this is NOT considered to be direct government funding.
***Academic Year and semester appointments minimum funding requirements:
$1,100/ month/ individual
$550/month for spouse
$275/ month per each child
$1,000/ initial adjustment expenses
J-2 Dependents (Dependents who will accompany the J-1 visitor)
Name (first,
middle, last
Date of Birth
(mo/day/year)
Country and
City of Birth
Country of
Citizenship
Country of Legal
Perm. Res.
Gender
F or M
Relationship
Mailing the Form
The Office of International Education can send the DS-2019 to the prospective visitor or the department may
mail it. Please indicate your preference: [ ] OIE [ ] Department
Address (home country)
__________________________
__________________________
Host Faculty or Host Department Contact Authorization
Name of Host Faculty or Department _________________________________________________________________
Host Faculty or Department Contact (Name, Email, Phone)________________________________________________
________________________________________________________________
Signature
Date
For questions related to J-1 Scholars and Beloit College policy on immigration issues, please contact Josie Inaldo, International
Student Advisor, 363-2659, inaldoj@beloit.edu.