Application For Washington State J-1 Physician Visa Waiver Program Page 2
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9b. ONLY if physician does not yet have an active license under chapter 18.71 or 18.57
RCW, a copy of medical degree with certified translation if necessary and proof of
passage of examination
16. Specialty Waiver Addendum and supporting documentation (if applicable)
17. Non-HPSA Waiver Addendum and supporting documentation (if applicable)
Secondary application package, only include the documents listed below.
1. U.S. Department of State Data Sheet
2. Employment contract
3. Physician attestation that no other waiver application is pending
4. All U.S. Department of State DS-2019 forms (Certificate of Exchange visitor status)
5. Letter from applicant requesting waiver sponsorship
6. Evidence of HPSA designation status (if applicable)
7. Physician statement describing reason for not wishing to fulfill the two year home country
residency requirement
8. Current curriculum vitae for the physician
9. An explanation for any time out of J-1status (if applicable)
10. USCIS G-28 Notice of Entry of Appearance from attorney (if applicable)
11. USCIS I-94 entry and departure cards
12. Copy of “No Objection” letter or a signed statement that a “No Objection” letter is not required
All applications must be received by U.S. postal mail, commercial mail carrier, or be hand delivered.
Address for commercial mail carrier or hand delivery:
Washington State Department of Health
Office of Community Health Systems
Attention: J-1 Visa Waiver Program
111 Israel Road SE
Tumwater, WA 98501
Address for U.S. Postal Service:
Washington State Department of Health
Office of Community Health Systems
Attention: J-1 Visa Waiver Program
PO Box 47853
Olympia, WA 98504-7853
Applications will be accepted beginning October 1 of each federal fiscal year until all sponsorships
have been filled. Applications received after all slots have been filled for the year will be returned to
the applicant and may be resubmitted during the next application cycle.
The applicant will be notified in writing of the department’s decision. If approved, the department
will add the necessary documentation that indicates our intention to act as a sponsor and will forward
the secondary application package to the U.S. Department of State. You will be notified by the U.S.
Department of State of their approval or denial. The department’s approval does not guarantee
approval from the U.S. Department of State or the U.S. Citizenship and Immigration Services.
DOH 346-003 September 2016
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