Form Ds-7002 - Training/internship Placement Plan
Download a blank fillable Form Ds-7002 - Training/internship Placement Plan in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Ds-7002 - Training/internship Placement Plan with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4*OMB APPROVAL NO. 1405-0170
U.S. Department of State
EXPIRATION DATE: 03-31-2018
ESTIMATED BURDEN: 1.5 hours
TRAINING/INTERNSHIP PLACEMENT PLAN
SECTION 1: ADDITIONAL EXCHANGE VISITOR INFORMATION
Trainee/Intern Name (Surname/Primary, Given Name(s) (must match passport name)
E-mail Address
Program Sponsor
Program Category
Occupational Category
Current Field of Study/Profession
Experience in Field (number of years)
Type of Degree or Certificate
Date Awarded (mm-dd-yyyy) or Expected
Training/Internship Dates (mm-dd-yyyy)
From
To
SECTION 2: COMPENSATION
Organization Name
Address
Suite
City
State
ZIP Code
Website URL
Employer ID Number (EIN)
Exchange Visitor
Compensation
If Yes, how much?
Stipend
Yes
No
Hours Per Week
Non-Monetary
per
Compensation Value
Workers' Compensation Policy
Does your Workers' Compensation policy cover
exchange Visitors?
Yes
No, exempt
Yes
No If so, Name of Carrier
No, but equivalent coverage
Number of FT Employees Onsite at
Annual Revenue
Location
$0 to $3 Million
$3 Million to $10 Million
$10 Million to $25 Million
$25 Million or More
SECTION 3: CERTIFICATIONS
Trainee/Intern - I certify that:
1. I have reviewed, understand, and will follow this Training/Internship Placement Plan (T/IPP);
I am entering into this Exchange Visitor Program in order to participate as a Trainee or Intern as delineated in this T/IPP and not simply to
2.
engage in labor or work within the United States.
I understand that the intent of the Exchange Visitor Program is to allow me to enhance my skills and gain exposure to U.S. culture and business
3.
in a way that will be useful to me when I return home upon completion of my program.
I understand that my internship/training will take place only at the organization listed on this T/IPP and that working at another organization while
4.
on the Exchange Visitor Program is prohibited.
5.
I will contact the Sponsor at the earliest available opportunity regarding any concerns, changes in, or deviations from this T/IPP.
6. I will respond in a timely way to all inquiries and monitoring activities of my sponsor.
7. I will follow all of my sponsor's guidelines required for my participation in my program.
8. I will contact the U.S. Department of State's Bureau of Educational and Cultural Affairs (ECA) at the earliest possible opportunity if I believe that
my sponsor or supervisor (as set forth on page 3, section 4), is not providing me with a legitimate internship or training, as delineated on my
T/IPP; and
9. I declare and affirm under penalty of perjury that the statements and information made herein are true and correct to the best of my knowledge,
information and belief. The law provides severe penalties for knowingly and willfully falsifying or concealing a material fact, or using any false
document in the submission of this form.
Printed Name of Trainee/Intern
Date (mm-dd-yyyy)
Signature of Trainee/Intern
DS-7002
Page 1 of 4
03-2015
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal