Ds-2019 Request Form
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3Scholar’s E-mail Address__________________________________
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PART I-SCHOLAR INFORMATION
1.Name of Scholar: ___________________________________________/_______________________________________________________
Family/Last Name
Given/First Name(s) (including middle name)
2. Male/Female: _____________
3. Date of Birth: _____/____/______ 4. Place of Birth: _________________/___________________ _
Month/ Day /Year
City
Country
5. Citizen of: _______________________________________
6.Legal Permanent Resident of: ______________________________________
Country
Country
7. Occupation, Employer & City of employer in country of permanent residence:
__________________________________________________________________________________________________________________
8. Highest degree received (check one):
_____Ph.D
_____Masters
_____Other (identify)
(If less than master’s degree, justify designation as a scholar):
_________________________________________________________________________________________________________________
9. What is the basis of your determination that this person has adequate English skills to function as a Visiting Scholar in your department?
__________________________________________________________________________________________________________________
10. Has this Scholar held J-1 or J-2 immigration status at any U.S. institution in the past 12 months? (Yes/No)__________
If yes, give dates, location and purpose of most recent visit:________________________________________________________________
(Attach copies of all previous IAP-66 or DS-2019 forms and, if the scholar is in the U.S., a copy of both sides of his or her Form I-94)
Note: a Scholar may not change J-1 category, e.g., student to scholar, in the U.S.
11. Has this Scholar previously visited UNL with the J-1 visa? (Yes/No)_______ If yes, give most recent dates: ___________________________
______________________________________________________________________________________________________________
PART II-PROGRAM INFORMATION
12. Scholar’s academic field: _________________________________________________________________________________________
13. Area of specialization: ___________________________________________________________________________________________
14. Description of Scholar’s proposed activities at UNL: (Examples: conduct research in atomic physics; teach courses in Italian; conduct
three-day workshop in ecology; observe university administration.)
_______________________________________________________________________________________________________________
15. Dates of visit at UNL: from_______________________________________
to_______________________________ _______________
Dates should include program dates ONLY , they can not include additional time for tourist or non-program activities.
A visiting Professor/Research Scholar on a J-1 visa may be documented to stay in the U.S. for a maximum of three years, although an
extension of six months may be permitted for good cause to complete teaching or research responsibilities. An individual is not eligible to
begin a new program in the “Professor or Research Scholar” category if he/she has been physically present in the U.S. in J-1 or J-2 status
for six months or more of the 12 month period immediately preceding the proposed starting date of the new exchange program; however, a
Professor/Research scholar currently in the U.S. in the J-1 visa classification status may transfer to a different Exchange Visitor (J-1)
program.
16. Is there a possibility that Scholar will extend his or her stay at UNL beyond the dates given above? (Yes/No)_______
If yes, will Scholar extend their stay by a total of more than six months (Yes/No)_______
17. Proposed job title at UNL (the J-1 visa may not be used for tenured or tenure-track positions):_________________________________
18. Will the Scholar be employed by or visiting other U.S. institutions before or after the UNL visit? (Yes/No)___________
If yes, give details on separate sheet or call the ISSO to discuss. (A J-1 Scholar is permitted to remain in U.S. for up to 30 days of travel
after completing the UNL program without special permission; no employment is permitted during this period.)
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