Ds-2019 Application Form - Documentation To Be Submitted To The Ifss Office Page 6
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7Section 3: Information about the Appointment
(UW-Madison host department must complete, please print clearly)
Eligibility for J-1 Scholar categories: Professor, Research Scholar, Short Term Scholar or Specialist
Short Term Scholars cannot extend their J-1 Program beyond six months.
If the total visit may extend beyond six months, please check here
Beginning
Ending
Dates of Program
(mm/dd/yyyy)
(mm/dd/yyyy)
UW Academic Staff Title offered
Host department
Visitor's primary UW activity
T eaching
Research
Observation
Consultation
Visitor’s site of activity will be outside of UW
Y es
No
Visitor's field of specialization (see approved list)
Visitor will be supervised at UW-Madison by
Supervisor's telephone
E-mail
Section 4: Funding Information (in US dollars)
Attach: letter(s) or official bank statement in English to substantiate each funding source below
UW-Madison salary/stipend, if any $
per
month
duration of program
The UW-Madison sponsor
has
has not received funding from U.S. Government Agency(ies) to
directly support this exchange visitor’s program. If “has” indicate agency(ies) below.
*U.S. government funding does not include the “general” grants given to university professors, in which the
professors can spend the funding as they deem necessary from office materials to a UW-salary in order to achieve
research results.
U.S. Government (list agency)
$
per
International Organization (list agency)
$
per
Visitor's home Government
$
per
Visitor's personal funds
$
per
Other (specify)
$
per
Total
$
per
6
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