Northeastern University - Extension Of Ds-2019 For J-1 International Scholars (Form C)
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1
2Extension of DS-2019 for J-1
International Scholars (Form C)
The maximum duration of status for the J-1 Research Scholar and Professor categories is five years. The time is cumulative. Scholars
who transfer to Northeastern University from another employer must take note of any time already used. Additionally, scholars in
the J-1 Research Scholar/Professor categories are subject to the 24-month bar on “repeat participation”, once the scholar completes
their appointment in a J-1 Research/Professor category, they are barred from using the J-1 Professor/Research Scholar category for
a 24-month period. The 24-month bar will be in effect regardless of whether the scholar’s J-1 program is a few months or the full
five years. If, however, the scholar is at Northeastern for six months or less and is using the J-1 Short-Term Scholar category, the 24-
month bar does not apply. However, extensions cannot be approved beyond the six months for J-1 Short-Term Scholars. The
department and scholar are responsible for planning accordingly.
Instructions for Requesting a DS-2019 Extension:
Submit the below documents to the SEVIS Contact in your college:
•
Completed and signed Extension of DS-2019 for J-1 International Scholars (Form C)
•
Copy of the renewed Northeastern Appointment Letter signed by the Department Head or Dean
Completed and signed Statement of Compliance with Department of State Health Insurance Requirements for J-1 Exchange
•
Visitors (this form must be resubmitted for the J-1 Scholar and their dependents)
•
Financial documentation with translation into English and converted to U.S. currency
•
Completed Verification of English Language Proficiency Form, including the Faculty Host signature
Note: Documents must be submitted to the Office of Global Services (OGS) at least one month in advance of the expiration date
on the J-1 Scholar’s DS-2019.
Part I: Personal and Academic Information
Scholar’s Name: ______________________________________________________________________________________________
Last/Family Name
First/Given Name
Middle Name
Scholar’s NU Academic Appointment Title: _________________________________________
Dates of NU Academic Appointment (extended dates): ________ / ________ /_________ to _______ / _______ /___________
Month
Day
Year
Month
Day
Year
Brief description of teaching/research field and duties at Northeastern: __________________________________________________
____________________________________________________________________________________________________________
Scholar’s NU Work Address: _____________________________________________________ Phone (ext): ____________________
Scholar’s U.S. Address: _________________________________________________________________________________________
Email: __________________________________________
Does the scholar plan to travel outside of the U.S. before the effective start date of extension?
Yes*
No
*If yes, when: ________________________________________________________________________________
Has the scholar, if applicable, applied for 212 (e) waiver?
Yes*
No
Not Applicable
Part II: Financial Declaration and Certification
List the amounts from each source according to the list below, including additional funds required for dependents, if applicable. The
total should be an estimate of expenses for the full length of the program.
Please note, as per federal regulation, the J-1 Scholar must submit documentation to the OGS for all received or anticipated
scholarships, fellowships, etc. for the purpose of exchange, regardless of whether the scholar possesses sufficient personal funds for
the J-1 program. Receipt of direct funding from the U.S. or foreign government for the purpose of exchange will subject the scholar to
212 (e). Failure to disclose receipt of government funding to the appropriate official (Consular Officer, RO, ARO) can be a material
representation that may lead to detrimental consequences.
Office of Global Services, 405 Ell Hall, 360 Huntington Ave, Boston, MA 02115
northeastern.edu/ogs | ogs@northeastern.edu | (p) 617.373.2310 | (f) 617.373.8788
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