Application For Washington State J-1 Physician Visa Waiver Program
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9Application for Washington State J-1 Physician Visa Waiver Program
Please type or print clearly and read all instructions carefully. Complete all sections of this application
and attach required documentation in the requested order. Incomplete applications will be returned.
Please refer to Chapter 246-562 WAC for additional information. The Department of Health
(department) suggests, but it is not required, the applicant work with an immigration attorney to ensure
all steps are in place that will allow the physician to work in the United States.
If you have questions concerning this application, please contact the department’s
Office of Community
Health
Systems.
Application instructions
All documentation must have the U.S. Department of State Case Number on the bottom right
hand corner of each page.
Please use a single fastener to hold together the pages of the application. Do not use staples or
paperclips to attach documents together.
Order the two application packages in the following manner:
Main application package
1. Washington State J-1 Physician Visa Waiver Application
2. U.S. Department of State Data Sheet (DS-3035)
3. Employment contract
4. Physician attestation that no other waiver application is pending
5. All U.S. Department of State DS-2019 forms (Certificate of Exchange visitor status)
6. Letter from applicant requesting waiver sponsorship
7. Evidence of Health Professional Shortage Area (HPSA) designation status (if applicable)
8. Physician statement describing reason for not wishing to fulfill the two year home country
residency requirement
9. Current curriculum vitae for the physician
10. An explanation for any time out of J-1 status (if applicable)
11. USCIS G-28 Notice of Entry of Appearance from attorney (if applicable)
12. USCIS I-94 entry and departure cards
13. Copy of “No Objection” letter or a signed statement that a “No Objection” letter is not required
14. Supporting documents from applicant:
a. Sliding fee discount schedule, policy, and photograph of posted notice in patient waiting
area
b. Supporting documentation for a new practice location (if applicable, see question 5)
c. Single example from recruitment effort (see question 11)
15. Supporting documentation from physician:
a. Evidence of current status as medical resident or completion of medical residency
program
DOH 346-003 September 2016
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