Request For Ds-2019 Certificate Of Eligibility For Exchange Visitor Status
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1
2Request for DS-2019
Certificate of Eligibility for Exchange Visitor Status
Dean’s Office
1325 N. College Avenue, Claremont, CA 91711 Ph. (909)447-2521/2507 Fax (909)447-6327/6242/6241
sansu@cst.edu
A form DS-2019, Certificate of Eligibility for Exchange Visitor Status, is required for a J-1 visa. Please complete this form
and return it to the Responsible Officer at the Dean’s Office.
Name:
Birthdate:
month/day/year
first
middle
last/family
Passport Name:
Email:
Phone Number:
first
middle
last/family
Gender:
Place of Birth:
Male
Female
c
ity
country
Country of Citizenship:
Country of Legal Permanent Residence:
Permanent Address:
Mailing Address for DS-2019:
Position in home country
(graduate student, professor, etc.):
Estimated date of arrival in US:
Estimated date of departure from US:
month/day/year
month/day/year
Field of Research:
Describe proposed research:
Immediate family members who will accompany you:
Name:
Birthdate:
month/day/year
first
middle
last/family
Passport Name:
Email:
Relationship:
Spouse
Child
first
middle
last/family
Place of Birth:
Gender:
Male
Female
c
ity
country
Name:
Birthdate:
month/day/year
first
middle
last/family
Passport Name:
Email:
(optional)
Relationship:
Spouse
Child
first
middle
last/family
Place of Birth:
Gender:
Male
Female
c
ity
country
Name:
Birthdate:
month/day/year
first
middle
last/family
Passport Name:
Email:
(optional)
Relationship:
Spouse
Child
first
middle
last/family
Place of Birth:
Gender:
Male
Female
c
ity
country
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