International Student & Scholar Services
University of Massachusetts Boston
100 Morrissey Blvd, Boston, MA 02125
Block 2100, 2nd Floor, Campus Center
617-287-5586/ Fax: 617-287-3963
Email: isss@umb.edu
Updated: December 2012
VISITING RESEARCH SCHOLAR/PROFESSOR REQUEST FORM
Scholar & Faculty Host Contact Information
Host Faculty Member: ____________________ Dept. Contact Person (if different): _________________
Extension: ____________ Email: _______________________Department: ________________________
Name of Proposed Scholar: ________________________ Visitor’s Email: _________________________
Academic Degree(s) Held: _______________________________________________________________
Document Delivery
Please choose your preference:
_____ ISSS should call the contact person listed above when ready for picked up.
_____Visa documents should be mailed in University mail to the contact person.
Duration of Stay
Dates of Proposed Visit: _________________________________________________________________
Is it possible that this visit will be renewed or extended beyond this date?
Will the proposed visitor be accompanied by family members?
Yes / No
Yes / No / Not sure
Exact address where visitor will be working: _________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
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J-1 SCHOLAR REQUEST APPLICATION – 01/2013
Work Amenities
This information is for record keeping purposes only. Amenities are the hosting department’s
responsibility. Will the proposed visitor have access to (check all that apply and describe)?:
Office Space
A Computer
Administrative Support
Yes / No
Yes / No
Yes / No
Please describe the above and/or include additional amenities you are prepared to provide? _________
_____________________________________________________________________________________
_____________________________________________________________________________________
Visitor’s Principle Activities
What percent of the scholar’s time will be spent on:
Teaching
Research
Training
Study
Other
__________
__________
__________
__________
__________
Briefly describe the proposed activities/duties – this information will be input on the scholar’s visa
documents: ___________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Export Controls
My department has export controlled projects and I understand that restrictions may apply to add
Foreign Nationals to such a project or to have Foreign Nationals in the vicinity of any such project:
Yes / No
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J-1 SCHOLAR REQUEST APPLICATION – 01/2013
If yes, or not sure:
Before ISSS can issue visa documents you will need to contact Shemetra Owens in the Office of Research
& Sponsored Programs at shemetra.owens @umb.edu or Ext. 7-5478. You must attach written approval
to this Scholar Request Application.
Funding Information
The financial information here is the sole basis for determining whether or not the support will be
adequate to maintain a minimum decent standard of living without becoming a “public charge.” This
information will appear on the DS-2019 Certificate of Eligibility and will be the determining factor in
whether a visa is actually issued by the U.S. Embassy or consular official. Visitors should show a total
$1,500 per month for the Metro Boston area.
Funding Source
UMASS Boston
Grant paid to Exchange Visitor
Exchange Visitor’s Home Institution
Exchange Visitor’s Personal Funds
U.S. Government
Exchange Visitor’s Government
Amount
______________________
______________________
______________________
______________________
______________________
______________________
Per
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
Required Signatures
Without the required signatures it will be not be possible to process this Scholar Request.
Signature of Hosting Faculty Member
Date
Signature of Department Chair
Date
Signature of Dean
Date
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J-1 SCHOLAR REQUEST APPLICATION – 01/2013
For compliance/regulatory questions or questions regarding this form, please contact:
Susan Leigh Connors
Advisor to Visiting Scholars & Researchers
International Student & Scholar Services
2nd Floor, Campus Center, Block 2100 Office 2006,
Email: susan.connors@umb.edu, Ext. 7-4894
Fee for J Visa Scholar Servicing: Your J Visa Scholar servicing fee will be $450 USD. You must pay the fee
on the first day of your arrival to UMass Boston, in the Office of Inter-/Transnational Affairs (OITA),
room 2100, 2nd fl. Campus Center. We accept American Express Traveler Check or an officially certified
check (attention to UMass Boston, OITA - J Visa Scholar Servicing Fee).
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J-1 SCHOLAR REQUEST APPLICATION – 01/2013