DS-2019 Application - Instructions
Visiting Professors, Research Scholars, Short Term Scholars and Specialists
__________________________________________________________________________________
NOTE: Professors and Research Scholars may remain in the U.S. in J-1 status for up to three years. In some limited
instances, an extension beyond the three-year limit is possible. Short Term Scholars may remain in the U.S. for a maximum
of only six months and no extension of stay is permitted. Specialists are limited to a stay of one year, with an extension
possible only under exceptional circumstances and with Department of State approval. Therefore, it is important for the
department to determine the duration of the proposed stay before completing this form.
Procedure:
Hosting UW-Madison Department:
 Approves (after Dean/Division clearance as necessary) International Exchange Scholar invitation and J-visa request
 Completes DS-2019 request form including attachments, as required
 Forwards completed application packet to IFSS.
IFSS:
 Processes completed application packet
 Produces DS-2019 (approx. 10 working days)
 Dispatches visitor’s DS-2019 packet as instructed by department
 Upon visitor’s check-in at our office, copies immigration documents/schedules orientation
Visitor:
 Takes DS-2019, passport, UW appointment/invitation letter, and any other required financial documents to U.S. Consulate to
obtain J-1 visa stamp in passport;
 Uses DS-2019 and passport with J-1 visa stamp to enter the U.S.
 Checks-in with IFSS for required registration and to schedule orientation/welcome session
DS-2019 application (with all required attachments) may be dropped off, mailed or faxed (originals to follow by mail) to IFSS.
We will not process an incomplete application; instead, it will be returned to you for completion and resubmission. To avoid
this, be sure to include:
DS-2019 application form fully completed and signed by the department
Copy of Dean/Division approval notice if applicable
Copy of invitation/offer letter from the hosting UW-Madison Department on letterhead and signed
If not 100% funded by UW-Madison, documentation of all other funding source(s): e.g. letter(s) from official sponsor
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or
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official bank statement (in English or with English translation) on letterhead
Copy of passport information page for J-1 scholar and all dependents
For courier service delivery of DS-2019 to scholar: Completed airbill
Special Notes:
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For J-1 visa holders already in the U.S. a visa transfer may be required/allowed; contact IFSS for information. If a
transfer is permissible: include copies of all DS-2019s for current (and past, if applicable) program(s), copy of
passport expiration page, and copy of I-94 card.
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Questions:
For visitors who are M.D.s: a "5 point" letter from the Chair and Director of Clinical Affairs is required if the visit will
involve incidental patient contact.
Ischolars@bascom.wisc.edu. Or call IFSS at 265-4000
IAP-66 Application
Certificate of Eligibility for J-1 Scholar Visa: Professor, Research Scholar, Short
Term Scholar or Specialist
To begin a J scholar program at UW-Madison (for scholar not in the U.S., or in U.S. on other J-1 program )
(For extension or updates, please contact IFSS for more information.)
NOTE: Short Term Scholars may not stay in the U.S. for more than six months. No extension of stay is
permitted. If the total visit may extend beyond six months, please check here _____.
NOTE: Names of J-1 scholar and all dependents must appear exactly as in current passport.
Section 1: Information about the Scholar (Department or visitor may complete. Please Print Clearly.)
Name ____________________________ ______________________________ _____________________
last/family
first/given
middle
Gender ()  Male  Female
Date of Birth
City of Birth
Country of Birth
mm/dd/yy
Citizenship*
Country of Permanent Residence
*If scholar has dual citizenship, list country of passport in use for this visit.
Title/position in home country
Institution/employer in home county ______________________________________________
Highest (equivalent) degree held by visitor () Ph.D. Masters MD other (list)____________________
Visitor ()  has  has not previously been in the U.S. in J-1 or J-2 status.
If “has,” list dates of program(s), and Attach: copy of all previous IAP-66 forms.
Current mail address (with fax, e-mail if available)
______________________________________
Prospective UW-Madison dept. address
_______________________________________________
______________________________________
_______________________________________________
______________________________________
______________________________ Building #________
Accompanying Family Members (list only if traveling and entering the U.S. with the scholar)
(Legally wed spouse and minor unmarried children under the age of 21.)
Name
Relationship
Birth Date
City & Country of Birth Citizenship
Questions: Ischolars@bascom.wisc.edu or Kim Maday at 265-5114 or Deborah Ahlstedt at 265-4000
Section 2: Information about the Appointment: (UW-Madison host department to complete. Please print clearly.)
Dates of Program:
Beginning
Ending
mm/dd/yy
mm/dd/yy
UW Title offered
Host department _____________________________________________________________
Attach: Copy (the Exchange Visitor will need the original at the U.S. consulate and the port of entry)
of offer letter (if funded) or invitation letter (if non-funded/honorary position).
Visitor's primary UW activity ():  Teaching  Research  Observation  Consultation
Visitor's field of specialization ___________________________________________________
Visitor will be supervised at UW-Madison by ______________________________________
Supervisor's telephone
E-mail ___________________________
Section 3: Funding Information
(US dollars):
Attach: letter(s) or official bank statement in English to substantiate each funding source below.
UW-Madison salary/stipend, if any: $________________________ per  month  duration of program
The UW-Madison sponsor ():  has  has not received funding from U.S. Government Agency(ies) to
support this exchange visitor. If “has” indicate agency(ies) below.
U.S. Government (list agency) ______________________ $____________________ per________
International Organization (list agency) _______________ $____________________ per________
Visitor's home Government:
$____________________ per________
Visitor's personal funds:
$____________________ per ________
Other (specify): __________________________________
$____________________ per________
Total:
$___________________
per________
Insurance coverage for the duration of the program ():
 Visitor will purchase SHIP plan through UW-Madison.
 UW-Madison appointment includes health insurance; visitor will apply to SHIP for waiver.
 Visitor has other insurance and will apply to SHIP for waiver.
Section 4: Department Approval
______________________________________
Name, Title of Dept. Hiring Appointing Authority
Name of Department Contact Person
______________________________________
Signature
Contact Telephone / E-mail address
Date_______________________________
------------------------------------------------------------------------------------------------------------------------------------------------Dispatch instructions ():
Send IFSS correspondence to ():
 Departmental Pick-up.
 Department Contact person (name)_______________
 Express or courier service to visitor.
 Supervising professor/staff.
Attach: Completed airbill
 Hiring Authority.
Updated 4/16/2003