Fillable Academic Training Request Form printable pdf download

Academic Training Request Form

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International Student Services

459 Schmitz Hall, Box 355832

Seattle, WA 98195-5832

Phone: 206.221.7857 Fax: 206.543.9772

iss.washington.edu

Student Name: ____________________________

__________________________________________________

(Last/Surname)

(First)

Student ID #: ________________________

SEVIS ID #: N ______________________________________

Birth Date: ________________

Month/Day/Year

Email: ______________________________________

Phone Number: _____________________________________

ACADEMIC TRAINING REQUEST FORM

Step 1: Complete Student Section

Step 2: Email Academic Training Request Form (with Student Section completed) to your Academic Advisor or

Exchange Coordinator. They must complete the Advisor Section and print and sign the completed form.

Step 3: Submit completed Academic Training Request Form AND copy of job/internship offer to ISS.

Step 4: Allow five business days for processing. ISS will notify you when your new DS-2019 is ready for pick-up.

Student Section

Program of study at University of Washington:

Exchange Program for one, two, or three quarters; indicate UW exchange department/office below.

Note: it is your responsibility to notify your home university of your plans to participate in Academic Training after

completion of your UW exchange.

Study Abroad Office

Departmental Exchange: Department: ____________________

I am completing a degree at UW.

Have you been authorized for previous Academic Training?

Yes

If yes: How many days? _________

Academic Training is granted for up to 18 months or the same length of time as your program of study, which-

ever is shorter. Example: if your program of study is three quarters or 275 days, then your Academic Training

can only be granted for a maximum of 275 days. Post-doctoral students may be eligible for an additional 18

months.

Requested Academic Training Start Date: ___________________

Requested Academic Training End Date: ____________________

Is the requested end date after your program completion date?

Yes

If yes, you must also attach funding documentation and the Insurance Statement of Compliance Form.

Academic Training Request Form

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