J-1 Student Form

J-1 Exchange Student Intake Form (Reynolda Campus)

Please fill out the following form as accurately and completely as possible.

NOTE: ALL FINANCIAL INFORMATION MUST BE GATHERED BEFORE FILLING OUT THIS FORM. YOUR DS2019 CANNOT BE PROCESSED WITHOUT NUMERICAL FINANCIAL INFORMATION.

Family Name/Surname(Required)

Please use names as they appear in your passport.

First Name/Given Name(Required)

Passport Data Page Upload(Required)

Accepted file types: pdf, Max. file size: 23 MB.

Please upload a PDF version of your original passport data page. No pictures of the passport will be accepted.

Admission Letter Upload(Required)

Accepted file types: pdf, Max. file size: 23 MB.

Please upload a PDF version of your WFU Admission letter.

Gender(Required)

Female

Male

Other

Current Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Permanent Foreign Address (if different from above)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Phone(Required)

Date of birth(Required)

City of birth(Required)

Country of birth(Required)

Country of permanent residency(Required)

Country of citizenship(Required)

Current or last employment in your home country (i.e. national government, local government, nonprofit, private industry, etc.)(Required)

If you selected Goverment Employee, can you be more specific?

Place of Employment/Study in Home Country (Company or Institution)(Required)

Estimated start date of J-1 program(Required)

Estimated end date of J-1 program(Required)

Funding Information

Sufficient funding to support your stay in the U.S. is required. You must input the specific total monetary amount you will have available to support your stay. Please be sure to inquire with WFU and/or other organizations to find out what types of financial support you will have available to you prior to filling out this form. Refer to email instructions from ISS for detailed information on funding requirements. If a dependent will accompany you, an additional $1000 per dependent per month. It is acceptable to have multiple funding sources.

Note: It will not be possible to process the DS-2019 form without an estimate of the amount of finances that you will be receiving either from Wake Forest or an external organization. The funding document must be dated witin 6-months of submission to ISS.

Total amount of financial funding/benefits provided by Wake Forest(Required)

Tuition waiver, grant, scholarship, etc. – MUST BE NUMERICAL AMOUNTS, enter 0 if you will not be receiving any money from WFU

Dollar value of funding provided by other organizations(Required)

Funding provided by outside organizations – i.e. NOT WFU. You must list the total numeric amount of funding you will have available. If you will be funding yourself (or will be funded by family), please list at least $2,415 per month and list “personal savings” or “family savings” in field below entitled “Name(s) of all other organizations providing funding”. The funding document must be on letterhead and in English.

Name(s) of organization(s), other than WFU, who will provide funding

Please list “personal savings” or “family savings” if you will not be funded by an external organization.

Upload proof of finances(Required)

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 64 MB, Max. files: 5.

Examples: letter of employment, bank statements affirming current amounts in bank account, financial guarantees from third-party financial sponsors. If you have multiple sources of funding, please upload proof of all sources.

Additional information/comments

Visa Information

If currently in the U.S., what is your immigration status?

NOTE: If currently in J-1 Status and transferring to Wake Forest University, please also complete J-1 Transfer-In Form

Expiration Date (Month/Day/Year)

Within the past 24 months, have you been physically present in the U.S. in either the J-1 or J-2 category as a professor or research scholar (does not apply to the short-term scholar category) for a period of 6 months or longer?(Required)

Yes

Copies of Previous DS-2019s

Max. file size: 23 MB.

If on a J-1 visa now or in the last 24 months, please indicate your category (Please Include Copies of Previous DS-2019s)

Start date of J-1 Status (Month/ Day/ Year)

End date of J-1 Status (Month/ Day/ Year)

Program Sponsor (name/program number found on line 2 of DS-2019)

If in J visa status, have you applied for a waiver of 212(e), the Two-Year Home Residency Requirement?

Yes

If you have applied for waiver of the 212(e), has it been approved?

Yes

(If yes, please include a copy of the waiver approval)

Copy of 212(e) Wavier

Max. file size: 23 MB.

Addtional Information about previous Visa Status(es)

Dependent Information

How many dependents will accompany you?(Required)

If dependents will accompany you, please provide the following information for each.

Dependent 1 family name

Dependent 1 given name(s)

Dependent 1 date of birth

Dependent 1 city of birth

Dependent 1 country of birth

Dependent 1 country of citizenship

Dependent 1 relationship

Dependent 2 family name

Dependent 2 given name(s)

Dependent 2 date of birth

Dependent 2 city of birth

Dependent 2 country of birth

Dependent 2 country of citizenship

Dependent 2 relationship

Dependent 3 family name

Dependent 3 given name(s)

Dependent 3 date of birth

Dependent 3 city of birth

Dependent 3 country of birth

Dependent 3 country of citizenship

Dependent 3 relationship

Dependent 4 family name

Dependent 4 given name(s)

Dependent 4 date of birth

Dependent 4 city of birth

Dependent 4 country of birth

Dependent 4 country of citizenship

Dependent 4 relationship

Dependent 5 family name

Dependent 5 given name(s)

Dependent 5 date of birth

Dependent 5 city of birth

Dependent 5 country of birth

Dependent 5 country of citizenship

Dependent 5 relationship

This field is for validation purposes and should be left unchanged.

Center for Immigration Services and Support

J-1 Exchange Student Intake Form (Reynolda Campus)

Funding Information

Visa Information

Dependent Information

Where to start

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