East Carolina University
Greenville, North Carolina 27858-4353
Sandy Dumpor - Telephone: +1 252-737-4378
Fax: +1 252-328-4813
APPLICATION FOR A DS-2019 FORM
In order to issue a DS-2019, “Certificate of Eligibility for Exchange Visitor (J-1) Status,” the following
information is needed.
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NAME OF EXCHANGE VISITOR:
Click here to enter text.
CHECK ONE FOR EACH SET OF INFORMATION: ☐Male ☐Female
BIRTH DATE: Click here to enter text.
BIRTH PLACE: Click here to enter text.
COUNTRY OF CITIZENSHIP: Click here to enter text.
LEGAL PERMANENT RESIDENT IN: Click here to enter text.
7.
WHAT POSITION DOES THE VISITOR HOLD IN THEIR COUNTRY OF LEGAL PERMANENT RESIDENCE
(E.G., PROFESSOR, UNDERGRADUATE STUDENT, RESEARCHER):
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☐Single
☐Married
Position/Activity: Click here to enter text.
Institution/Company: Click here to enter text.
City and Country: Click here to enter text.
PERIOD OF STAY IN THE UNITED STATES: FROM:
TO:
Maximum anticipated stay (weeks, months, years): Click here to enter text.
9.
THE CATEGORY OF THIS VISITOR AT EAST CAROLINA UNIVERSITY WILL BE (DEFINITIONS, PAGE 5):
Student ☐
10.
Professor ☐
Research Scholar ☐
Short-Term Scholar ☐
Specialist ☐
DETAILED DESCRIPTION OF VISITOR’S PROGRAM AT ECU:
Major Field: Click here to enter text.
Minor Field: Click here to enter text.
Description of Research Work: Click here to enter text.
11.
PRIMARY RESPONSIBILITY AT ECU WILL BE:
Teaching ☐
Research ☐
☐ (Other, please explain): Click here to enter text.
12.
VISITOR’S SPECIFIC EDUCATIONAL FIELD: Click here to enter text.
13.
DATE AWARDED BACHELOR’S DEGREE: Click here to enter text.
14.
LIST ADDITIONAL DEGREES OR OTHER QUALIFICATIONS: Click here to enter text.
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Financial documentation:
The Exchange Visitor must have appropriate proof of financial support before the DS-2019 form is issued. The minimum funding
requirements for the J-1 Exchange Visitor are listed below.
J-1 EXCHANGE
VISITOR
$1500 per month
$18,000 per year
EXCHANGE VISITOR +
SPOUSE
$2150 per month
$25,800 per year
EXCHANGE VISITOR +
CHILD
$1850 per month
$22,200 per year
EXCHANGE VISITOR +
SPOUSE + CHILD
$2500 per month
$30,000 per year
EACH ADDITIONAL
CHILD
$350 per month
$4,200 per year
In addition to the standard estimates for living expenses and other costs for the individual, the Exchange Visitor will be expected to
show additional funds for each dependent accompanying them to the U.S.
Additional Funds Required for Dependent Coverage:
If dependents arrive in the U.S. initially, or at a later date, the EXCHANGE VISITOR must furnish personal financial documents to
show proof of sufficient funding for dependents while in the U.S.
If the Exchange Visitor must provide additional personal or family funding for dependent support, submit original bank
documents or copies of bank statements showing the specific amount of funds available. BANK DOCUMENTS MUST BE IN
ENGLISH. FUNDS MUST BE SHOWN IN U.S. DOLLARS.
Proof of Support Letter
If financial support is from any source other than East Carolina University, attach a proof of support letter. The proof of support
letter must be an official document, on letterhead from the funding source. Support letters should also show:
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the amount of financial support to be received,
the dates for which funding will be provided,
signature of a person in the organization who is authorized to guarantee funding,
an official stamp of the University;
whether or not stipend includes an amount for medical insurance.
15.
Financial Support: List each source and amount of funds (in U.S. dollars)
Exchange Visitor’s Government:
ECU Department:
$ Click here to enter text.
$ Click here to enter text.
Will any U.S. government funding be involved? YES ☐ NO ☐
a. If yes, state the name of agency providing funds: Click here to enter text.
b. Was this government funding received specifically for this Exchange Visitor? YES ☐ NO ☐
c. Was the funding received specifically designated for an Exchange Visitor program? YES ☐ NO ☐
FUNDING FROM:
U.S. Government Agency:
International Organization:
Personal Funds:
Other Funding Amount:
AGENCY NAME:
Click here to enter text.
Click here to enter text.
AMOUNT RECEIVED
$ Click here to enter text.
$ Click here to enter text.
$ Click here to enter text.
$ Click here to enter text.
Explain Other Funding Amount: Click here to enter text.
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16.
If the visitor has been in the U.S. previously as an exchange visitor (J-1 visa holder), please give
details of program: Click here to enter text.
Dates of Exchange Visitor program: From: Click here to enter a date. To: Click here to enter a date.
Dependent Information:
Will the Exchange Visitor bring immediate family members when arriving in the U.S.? YES ☐ NO ☐
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Only a lawful spouse and dependent children under the age of 21, who are not U.S. citizens or were
not born in the U.S. are eligible for J-2 dependent status.
Parents, siblings, children over the age of 21, servants, common-law spouses or paramours, samesex partners, and other friends or relatives are not eligible for J-2 dependent status.
It is sometimes beneficial for a J-1 Exchange Visitor to arrive alone at first, get settled, set-up an
apartment, and then invite family members to arrive later. Others prefer to bring immediate family
members with them.
If Yes, please provide the following information for each person, using information from the passport:
Last Name: Click here to enter text. First Name: Click here to enter text. Middle Name: Click here to enter text.
Relationship to Visitor:
Click here to enter text.
Place of Birth:
Click here to enter text.
Date of Birth:
Click here to enter text.
Present Nationality:
Click here to enter text.
Last Name: Click here to enter text. First Name: Click here to enter text. Middle Name: Click here to enter text.
Relationship to Visitor:
Click here to enter text.
Place of Birth:
Click here to enter text.
Date of Birth:
Click here to enter text.
Present Nationality:
Click here to enter text.
Last Name: Click here to enter text. First Name: Click here to enter text. Middle Name: Click here to enter text.
Relationship to Visitor:
Click here to enter text.
Place of Birth:
Click here to enter text.
Date of Birth:
Click here to enter text.
Present Nationality:
Click here to enter text.
Last Name: Click here to enter text. First Name: Click here to enter text. Middle Name: Click here to enter text.
Relationship to Visitor:
Click here to enter text.
Place of Birth:
Click here to enter text.
Date of Birth:
Click here to enter text.
Present Nationality:
Click here to enter text.
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17. If dependents are already in the U.S., provide:
Passport number:
Passport Expiration Date:
Country of Issuance:
Click here to enter text.
Click here to enter a date.
Click here to enter text.
18. This request is to: ☐ invite visitor from another country
☐ transfer from another J-1 program
☐change the status of an alien already in the U.S. to J-1 status
19.
If the EXCHANGE VISITOR is currently in the U.S., attach photocopies of the front and back of I-94
card, picture page of passport, and visa page. Include a copy of the DS-2019 form.
20.
IF THE EXCHANGE VISITOR IS CURRENTLY IN THE U.S.:
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present non-immigrant status is: Click here to enter text.
sponsor is: Click here to enter text.
present appointment: Click here to enter a date.
date of entry to the U.S. in the current status: Click here to enter a date.
permission to stay in the U.S. expires on: Click here to enter a date.
Social Security Number: Click here to enter text.
TO BE COMPLETED BY ECU DEPARTMENT:
22.
Sponsoring department: Click here to enter text.
23.
The individual within the Exchange Visitor’s department who will be responsible for the visitor is:
Name: Click here to enter text.
Campus Phone Number: Click here to enter text.
Campus Address: Click here to enter text.
24.
The person authorizing this appointment is:
Signature/Title:_____________________________________
DATE: Click here to enter a date.
Click here to enter text., Department Chair/Director
25.
The person authorizing this appointment is:
Signature/Title:_____________________________________
Click here to enter text., Department Dean
DATE: Click here to enter a date.
PLEASE RETURN THIS APPLICATION AT LEAST 2 MONTHS PRIOR TO THE EXCHANGE VISITOR’S ARRIVAL
DATE TO ALLOW SUFFICIENT TIME FOR PROCESSING.
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DEFINITIONS OF J-1 EXCHANGE VISITOR CATEGORIES
Student:
An individual who is studying in the United States pursuing a full course of study leading to, or culminating in
the award of a U.S. degree from a post-secondary educational institution; or who is engaged full-time in a
prescribed course of study of up to 24 months duration conducted by a post-secondary accredited
educational institution.
Professor: (Maximum stay is 5 years)
An individual primarily teaching, lecturing, observing, or consulting at a post-secondary accredited
educational institution, museum, library, or similar type institution. A professor may also conduct research,
unless disallowed by the sponsor.
Research Scholar: (Maximum stay is 5 years)
An individual primarily conducting research, observing, or consulting in connection with a research project at
research institutions, corporate research facilities, museums, libraries, post-secondary accredited educational
institutions, or similar types of institutions. The research scholar may also teach or lecture, unless disallowed
by the sponsor.
Short-Term Scholar: (Maximum stay is 6 months)
A professor, research scholar, or person with similar education or accomplishments coming to the United
States on a short-term visit for the purpose of lecturing, observing, consulting, training, or demonstrating
special skills at research institutions, museums, libraries, post-secondary accredited educational institutions,
or similar type of institutions.
Specialist: (Maximum stay is 1 year)
An individual who is an expert in a field of specialized knowledge or skill coming to the United States for
observing, consulting, or demonstrating special skills. Exception: professors, research scholars, short-term
scholars, and alien physicians in graduate medical education or training.
PLEASE NOTE:
Department sponsors are responsible for the effective administration of their exchange visitor programs.
Responsibilities include screening the prospective exchange visitors to ensure that they are eligible for
program participation, the program is suitable to the exchange visitor's background, needs, and experience;
and the exchange visitor possesses sufficient proficiency in the English language to participate in his or her
program.
Sponsors shall monitor, through employees, officers, agents, or third parties, the exchange visitors
participating in their programs.
(Definitions based on the Electronic Code of Federal Regulations, Title 22: Foreign Relations, PART 62, EXCHANGE VISITOR
PROGRAM, current as of July 9, 2012)
RExchange Visitorised SD: 5/21/2014
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