Ds-2019 Application Form - Documentation To Be Submitted To The Ifss Office Page 3
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7DS-2019 Application Form (
Documentation to be submitted to the IFSS Office located at 21 N. Park St., Suite 5101)
Names of J-1 scholar and all dependents MUST appear exactly as in current passport.
Provide copy of passport identity pages for scholar and all dependents
.
Section 1:
J-1 Scholar Biographical Information
(Department or scholar may complete. Please print clearly)
Name
Last/family name
first/given name
full middle name
(if applicable, NO Initials)
Gender
Male
Female
Date of Birth
(mm/dd/yyyy)
Marital Status
Single
Married
City of Birth
Country of Birth
Country of Citizenship*
Country of Permanent Residence
*If scholar has dual citizenship, list country of passport in use for this visit.
Current Title/position
Current Institution/employer
(Prospective scholar must have a COMPLETED undergraduate degree to be eligible for UW J-1 Scholar
Program)
Highest (equivalent) degree completed by scholar
Ph.D.
Masters
MD
other (list)
Visitor
has
has not previously been in the U.S. in J-1 or J-2 status.
If scholar “has,” list dates of program(s) below and Attach: copies of all previous DS-2019 forms (if
scholar has the forms; otherwise just put down the dates of previous visits)
.
Scholar’s current mailing address
City/Province
Country
Zip Code
Telephone number
Scholar’s E-mail Address
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