J-1 Academic Training Record Form
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1
2SDSU International Student Center
J-1 Academic Training
Record Form
Only for J-1 students on the SDSU DS-2019 form
Application Steps
1. Receive employment offer from company
2. Fill out Academic Training form and meet with SDSU department chair or graduate advisor for
recommendation (the department listed on your DS-2019 form)
3. Meet with ISC advisor during Wednesday walk-in hours 1:30 – 3:30; bring completed form & copy of
job offer
Name: _____________________________________________
RED ID #: _______________________________
SDSU Major: _______________________________________
Phone #_________________________________
I am requesting training
During my SDSU program of study
After my SDSU program completion
Requested Beginning Date ______________________________
Requested Ending Date ___________________________
Number of hours per week _________________ Job Title __________________________________________________
Name of Company ________________________________________________________________________________________
Company Address ___________________________________________City ________________State _____Zip _____
Supervisor Name and Contact Information ___________________________________________________________________
Goals/Objectives of the proposed Training: ___________________________________________________________________
_________________________________________________________________________________________________________
Signature ______________________________
Date: ______________________________
Academic Department Recommendation
Advisor Name _________________________________________ Telephone or Extension ______________________
Advisor Title ___________________________________________ Department ________________________________
Recommended Dates from _______________________ to _______________________
Academic Training is recommended
Part time (0-20 hours)
Full time (21-40 hours)
Please state how job/internship is related to student’s field of studies: ______________________________________________
___________________________________________________________________________________________________________
It is my belief that the proposed training is related or an integral part of the student’s academic program.
Signature: ______________________________ Date: ______________________________
FOR OFFICE USE ONLY – For DS-2019 Extensions
Proof of Financial Funds
___________________
____________
Advisor Initials
Date
New Financial Statement Form ___________________ ____________
Advisor Initials
Date
Proof of Health Insurance
___________________ ____________
Advisor Initials
Date
J-1 Academic Training Information
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