Request For Ds-2019 Certificate Of Eligibility For Exchange Visitor Status Page 2
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1
2REQUIREMENTS TO SUBMIT TOGETHER WITH THIS FORM:
I.
Insurance – You are required to have medical insurance in effect for yourself and any dependents for the duration of your
program. Willful failure on your part to maintain the required insurance throughout your stay in the United States will
result in the termination of your exchange program. Listed below are the minimum requirements:
(1) medical benefits of at least $100,000 per person per accident or illness
(2) repatriation of remains in the amount of $25,000
(3) expenses associated with medical evacuation in the amount of $50,000
(4) does not have a deductible that exceeds $500 per accident or illness
II.
Financial Requirements:
In order to have a DS-2019 issued for you, you must show sufficient financial support as follows:
Living Expenses per month of stay
$ 1,600
X
number of months
=
$
number of months
Dependent Spouse per month of stay
$
333
X
=
$
Dependent Child per month of stay
$
188
X
=
$
number of months
TOTAL REQUIRED: $
III.
Financial Support Sources
Please enter the source and amount of your financial support during your stay, preferably in U.S. dollars ($). For each
source entered below, you must provide original documents verifying the amount. The Total amount must be equal to or
more than the Total required. Please print all entries.
Source
Amount (USD)
Personal Savings: (please enter Bank Name(s))
Employer Name:
Government/Private Scholarships: (please enter name below)
Total Amount from all sources:
Please attach and return the original financial documents with this form to the Responsible Officer (sansu@cst.edu).
IV.
English Language Proficiency
Participants must possess sufficient proficiency in the English language to participate in their programs. [22 CFR
62.10(a)(2)]
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