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Request to sponsor

an exchange visitor

 

The purpose of this application is to:

• ( ) Begin a new program          
• ( ) Extend a continuing program        
• ( ) Transfer from another program

Please provide the information with requested documentation for the issuance of a DS 2019 form.  This application, along with the requested documentation should be returned at least three months before the anticipated start date, in order to allow enough time for consular review.

 

Name of Faculty Sponsor:_____________________________________

   

Campus Phone #: ____________________________________________

Alternate Contact: ___________________________________________ 

  

Department/School:_________________________________________

 

If this application is for a scholar/student wishing to transfer from another institution, please ask the prospective exchange visitor if s/he has applied for a waiver of section 212e.  __yes  ___no

 

Visitor Information:

 

(  ) Male           (  ) Female              Date of Birth     ____/ ____/ ____
                                                                           mm     dd      yyyy  

 

Family Name               First name                          Middle Name

 

____________________________________________________________

 

City of Birth                                                                  Country of Birth

 

____________________________________________________________

 

Country of Citizenship                    Country of Legal Permanent Residence

 

____________________________________________________________

 

Highest Degree Obtained:  ____________       (Attach copy of degree)

 

Visitor’s occupation and place of employment in the home country:

 

____________________________________________________________

 

If the visitor anticipates accompaniment by family members, please complete attached J-2 dependent information form.

Address and phone number where immigration documents should be sent:

 

____________________________________________________________

____________________________________________________________

____________________________________________________________

 

Activity Information:

Dates of Stay:   From _________________To_______________________
                                 mm/dd/yyyy               mm/dd/yyyy           

Category of Visitor: 

• (  ) student on proscribed course of study 
• (  ) Professor 
• (  ) Researcher 
• (  ) Short-Term Scholar

A letter of offer/invitation to the visitor should be attached that provides a detailed description of activities and compensation. For students participating in exchange programs, please contact the study abroad office for information on application. 

 

Funding Information:

Indicate below the source(s) of funding and an estimate amount of money or in-kind contribution (rounded to the nearest dollar) the visitor will receive during the length of the program as will be indicated on the DS 2019:

 

1.  (  ) UNC Pembroke  (Includes positions funded by grants) $ _________

2.  (  ) US Government Agency                                            $ __________

3.  (  ) International Organizations                                       $ __________

4.  (  ) Exchange Visitor’s Government                                 $ __________

5.  (  ) Binational Commission of the visitor’s country             $ _________

6.  (  ) All other organizations                                               $ _________

7.  (  ) Personal Funds                                                         $ _________

 

 

Please attach supporting documentation on funding amounts and sources

 

Health Insurance:

 

Please be advised that federal regulations governing the Exchange Visitor Program require that all exchange visitors must have health/accident insurance coverage that includes repatriation and medical evacuation coverage.  Regulations do not require that UNCP pay for the insurance coverage, but must ensure that the exchange visitor and all accompanying dependents are properly covered for the duration of their stay.  The Office of International Programs offers an insurance plan for purchase.  Please contact International Student and Scholar Services for details.

 

Please indicate who will be responsible for health insurance coverage:

 

____________ sponsoring department     _____________exchange visitor

 

Please note that the exchange visitor visa program cannot be used for activities primarily conducted apart from UNCP.   

 

Updated: Wednesday, May 5, 2010

 

Return to International Student/Scholar Services

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