DS-2019 Department Request for Exchange Visitor (EV)

Apply to an American consulate for a J-1 visa to ENTER the United StatesTRANSFER TO UK from another U.S. institutionApply for CHANGE OF STATUS TO J-1 within the United States

JV Account Number*

UK Department*

Surname (Family)*

Given (First)*

Middle

Please provide a start date at least 4 months into the future to allow plenty of time for processing.

Start Date*

Date

End Date*

Date

EV’s will not be allowed to enter the United States more than 30 days before or 30 days after the start date indicated on the DS-2019. If the EV’s arrival is going to be delayed beyond the program start date, please contact valerie.pitts@uky.edu to proceed with an amendment

US State Department Definitions

Research ScholarShort-Term ScholarSpecialistStudent Intern

UK Human Resources Definitions

Postdoctoral ScholarVisiting ScholarVisiting Student

Subject or Field of Engagement (such as biomedical sciences, engineering, etc.)*

**Find the correct code here (EX: 01.0001). Please note that the subject or field of engagement may not be changed for the duration of the EV's DS-2019.

Enter Detailed Explanation of Research & Duties This Exchange Visitor Will Be Doing*

Source of Funding*

Per Month (USD)*

Per Year (USD)*

Funding must be secured for the initial period requested. Minimum funding required:

J-1 Scholar: $ 22,000
J-1 Scholar and Spouse: $ 28,800
Each child, an additional: $ 4,700

UK funding?*

YesNo

UK funding. Specify grant account number(s)*

Non-UK funding. Provide an official letter from the funding source specifying the duration of stay and amount of funding in U.S. currency.*

Professor who will be working with the candidate*

First NameLast Name

Professor Phone Number*

Professor Email*

example@example.com

Working address (at UK) of candidate:

Street Address*

(Example: 512 Administration Drive)

Lab/ Room #*

(Example: FPAT)

Zip*

City*

State*

The Photocopy of the offer letter from the Business Office*

Is the participant a physician?*

YesNo

If the participant is a physician, an additional letter from the Dean of the Medical School or designee is required. This letter should indicate that the research program either does not involve patient contact/care or it involves only incidental patient contact.*

By approving this form, I request a DS-2019 “Certificate of Eligibility” for this candidate. I understand that I am responsible for the processing fees charged by the International Student and Scholar Services (ISSS).

The fee will be charged to me by a journal voucher prepared by ISSS.

DS-2019 Department Request for Exchange Visitor (EV)

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