College of Engineering Visiting Scholar Information

Today's Date

Department Number*

Department Administrative contact name:

Department Administrative contact email:

example@example.com

Name of J-1 Scholar

UK ID#

Birthdate:

Date

HR Official Title

New end Date of DS-2019

Date

Detailed Reason for Extension*

Is this person a graduate student in their home country?

YesNo

If yes, upload visiting student approval form from Grad School.

Is the Department sponsoring the student?

YesNo

Enter funding amount for the extension:

Enter Grant #

Will personal funds be used?

YesNo

Enter funding amount for the extension:

If yes, upload visiting student approval form from Grad School.

Is the exchange visitor's government providing funding? *****If yes, please confirm that this is foreign government funding. This will automatically trigger the two-year home country rule for this exchange visitor. Please verify that this is NOT a foreign agency.

YesNo

Enter Amount of Funding from Exchange Visitor's Government for the entire stay:

Upload proof of funding from visitor's government.

Is a US Government Agency providing funding?

YesNo

Enter Agency Name:

Enter US Government Agency funding for entire stay:

Will the visiting scholar have funding from another source?

YesNo

Describe Source:

Enter funding for the entire stay for other source:

Upload proof or other funding.

Is the exchange visitor on a UK Employee Health Plan?

YesNo

Upload Proof of Insurance

Upload Medical Evacuation & Repatriation insurance for extension period.

JV Account #

Name of Final Approver (Requesting Faculty)

Email of Final Approver

example@example.com

VISA Coordinator

example@example.com

College of Engineering J-1 Scholar

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