J-1 Exchange Student/Scholar Application Form

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Part I: J-1 Exchange Visitor Biographical Information (as it appears on visitor's passport)

Dr. Mr. Mrs. Ms.

Email Address*

Name*

First Name

Middle Name (optional)

Last Name

Date of Birth*

MM/DD/YYYY

Gender *

Male Female

City of Birth*

Country of Birth*

Country of Citizenship *

Permanent Residence *

Is the Exchange Visitor currently in the U.S.?*

Yes No

List Date Range in the U.S. *

From MM/DD/YYYY to MM/DD/YYYY

Current US Address*

Address Line 1

Address Line 2

City

State

ZIP Code

What position does the Exchange Visitor currently hold in their home country?*

Part II: J-1 Exchange Visitor Academic Background

Must submit complete academic transcripts for each college degree translated to English

Number of Universities Exchange Visitor Attended*

1 2 3 4

Name of University 1*

Country of University 1*

Date of Enrollment at University 1*

From MM/DD/YYYY to MM/DD/YYYY

Degree Conferred at University 1*

Name of University 2*

Country of University 2*

Date of Enrollment at University 2*

From MM/DD/YYYY to MM/DD/YYYY

Degree Conferred at University 2*

Name of University 3*

Country of University 3*

Date of Enrollment at University 3*

From MM/DD/YYYY to MM/DD/YYYY

Degree Conferred at University 3*

Name of University 4*

Country of University 4*

Date of Enrollment at University 4*

From MM/DD/YYYY to MM/DD/YYYY

Degree Conferred at University 4*

Part III: Lamar University- Academic Program Information

Name of Hosting Supervisor*

First Name

Middle Name (optional)

Last Name

Email*

Phone No: *

Fax No:

J-1 Students enrolling into semester-length classes will be required to have their Program Start and End Dates reflect the published LU Academic Calendar. Though you may approximate the Program Dates below, our office will be required to adjust any dates to best match the available semester dates and your invitation letter.

Program Start Date*

MM/DD/YYYY

Program End Date*

MM/DD/YYYY

How will the Exchange Visitor be financially funded for their stay at Lamar University? *

Lamar University Self-Funded Home Country Government Home Institution U.S. Government

Other:

Description of Hosting Supervisor's Field of Study, Research, Teaching:*

Description of Program for Exchange Visitor ( What will they do at Lamar University?)*

Part IV: Financial Support

Federal regulations require Lamar University to obtain from you a certification that you have adequate financial resources to meet all expenses related to your program. Identify below the sources of funding available to you for the period of your stay. Identify each source of funding and the amount of financial support provided in U.S. currency. For funding sources other than Lamar University (if applicable), please provide evidence of support (must be an original and currently dated)

Amount in U.S. Dollars*

Funding Source*

(i.e Scholarship, Government, etc.)

Amount in U.S. Dollars

Funding Source

(i.e Scholarship, Government, etc.)

Exchange Visitor Mailing Address

Mailing Address to Receive DS-2019 Form *

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Exchange Visitor Phone #*

Exchange Visitor Fax #

Supervisor's Visa Request Form*

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