Exchange Visitor Info Form For J1 Visa Status Extension
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1
2
3Mailing address:
1120 15th Street, AA-2013
Augusta, Georgia, 30912
t. (706) 721-0670 f. (706) 721-9304
Email: ipso@augusta.edu
EXCHANGE VISITOR INFO FORM FOR J-1 VISA STATUS EXTENSION
(To be completed by the current Exchange Visitor)
Dear Current J-1 Exchange Visitor (EV): You may request an extension of your J-1 program up to six (6) months prior
to the expiration of your current DS-2019 Certificate of Eligibility for Exchange Visitors (J-1 Visa) Status.
Check List
Request an appointment for J program extension at
Step 1
/appointmentrequest.php
Complete the Exchange Visitor Information Extension Form found at
Step 2
/international/internatforms.php
Gather your
immigration documents and those of all family members in J-2 status
Step 3
original
including;
- Valid passports
- Form I-94 records
- Most recent DS-2019 Certificate of Eligibility for J-1
AND — very important
If any of your J program funding is from sources other than Augusta University (for example home government
funding, home institution funding, personal funding, sabbatical funding, etc.) then do step 4.
Get original funding documentation dated within 180 days of your J program extension
Step 4
appointment
BRING ALL DOCUMENTS TO THE SCHEDULED APPOINTMENT.
INSURANCE NOTIFICATION
The Exchange Visitor Program requires all program sponsors to notify their Exchange Visitors that they and their
dependents must have insurance coverage that meets the minimum standard established by the United States
Department of State (DOS). This policy must be valid for the entire duration of the exchange program.
Minimum coverage shall provide:
Medical benefits of at least $100,000 per accident or illness;
Repatriation of remains in the amount of at least $25,000;
Medical evacuation to the Exchange Visitor’s home country in the amount of at least $50,000; and
A deductible that does not exceed $500 per accident or illness.
Exchange Visitors are required to sign a statement certifying understanding and compliance with this requirement.
Exchange Visitors understand that failure to comply with this DOS requirement may result in termination of their
program of activity. Exchange Visitors may be subject to the requirements of the Affordable Care Act.
Date: __________________
Exchange Visitor Signature:
Print Name: _________________________________________________________________
1120 15th Street, AA‐2013, Augusta, GA 30912
P (706) 721‐0670 F (706) 721‐9304 |
gru.edu/diversity/ipso
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