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2. OPEN the file in a PDF viewer (such as Adobe Reader). This will allow you to save your work along the way.

Completed application form (don’t forget Section 2 U of M ID for the scholar)

Obtained department mentor & head signatures

Completed ISSS Fee Form

Obtained signed Statement of Responsibilities (scholar can sign, scan/send to department)

Copy of scholar’s passport (bio pages only)

Copies of J-2 dependent passports (if applicable)

Copies of scholar’s current visa documents (if applicable)

Copies of scholar’s past DS-2019s (if applicable, from past 2 years only)

Copy of funding documentation

Department invitation letter / offer letter (dates requested for DS-2019 match in letter)

English Proficiency Form, documentation (not needed if “Native English Speaker” is selected)

Incidental Patient Contact Letter (if applicable)

Completed China/Taiwan J-1 Visitor Google Form (only if inviting a Chinese/Taiwanese scholar)

The following does not need to be sent to ISSS, but should be provided to the scholar.

Completed U of M Insurance Forms (scholar can complete and submit insurance forms before arrival or once they arrive in U.S.)

ProsPective J-1 scholar aPPlication

Purpose?Submitting this application to ISSS is the first step of inviting a J-1 scholar to the U of M. This is to request a DS-2019 (Certificate of Eligibility) for the scholar who will need it to obtain their J-1 status.

Who completes this request?The hosting U of M department and the scholar complete this. It must be submitted by the U of M department to ISSS.

What happens after we submit this?ISSS will review it, and, if approved, will process a DS-2019 for the scholar. We’ll contact the Department Contact indicated in the applica-tion if more information is needed. That person will be notified when the DS-2019 is ready.

How long will this take?We try to accommodate start dates, but typically it takes 2-3 weeks for us to process this request.

What info is needed for this request? • Section 1: U of M Hosting Department & Contact

• Section 2: Prospective Scholar Contact Information

• Section 3: Scholar Background Information

• Section 4: U of M Program Information

• Section 5: U.S. Presence

• Section 6: Dependents

• Section 7: Financial Support

• Section 8: U of M Department Signatures

• Fee Form (department budget information for $310 fee)

• Statement of Responsibilities

• English Proficiency Form

• Detailed instructions: http://z.umn.edu/isssHelp

When ready to submit your request, use this checklist to help you make sure everything’s gathered.CheCklist

InternatIonal Student & Scholar ServIceS 190 Humphrey, 301 - 19th Avenue S Minneapolis, MN 55455 U.S.A. (612) 626-7100 Fax (612) 626-7361 isss@umn.edu www.isss.umn.edu

A. To: isssjdoc@umn.eduSubject: [Scholar’s Name] J Scholar Application

B. ISSSc/o J Visa Coordinator190 Humphrey School 301 19th Ave. S Minneapolis, MN 55455

send to isss Choose A. or B.

to request a DS-2019 for a prospective J-1 Research Scholar, Professor, or Short Term Scholar

Find next steps, FAQs, and more: http://isss.umn.edu/Departments/Jvisa

SectIon 1: u of M hoStIng departMent & contact

Department Name

Postal CodeStateCity

Address 2Address

Contact Name

PhoneEmail

Contact person must be staff or faculty at the U of M and will be contacted by ISSS for questions and DS-2019 preparation notification.

SectIon 2: proSpectIve Scholar contact InforMatIon

U of M ID (Provided by department)

Current Email

Date of Birth (mm/dd/yyyy)

Gender

Passport Given Name(s)Passport Surname(s)

City of Birth

Permanent Address in home country

Current Phone

Country of Legal Permanent ResidenceCountry of Citizenship

Preferred Name(s) optional

Prospective J-1 Scholar Application

Country of Birth

International Student and Scholar ServicesUniversity of Minnesota

Home Country Position Description Position Code (xxx)Use the tables (http://isss.umn.edu/j/jFieldCode/ ) to find the most fitting code to describe the scholar’s current/last position in their home country.1.

2. Is the scholar an undergraduate student in his/her home country who has not yet completed abachelor’s degree?*If yes, STOP. Ineligible for J-1 scholar DS-2019. Another visa/status must be pursued.

3. Is the scholar a medical student?*If yes, a residency program is not allowed as a J-1 scholar. Another visa/status must be pursued for residency.

SectIon 3: Scholar Background InforMatIon

Yes*No

Yes*No

to request a DS-2019 for a prospective J-1 Research Scholar, Professor, or Short Term Scholar

http://z.umn.edu/isssHelp 1 Updated 04/16/15

6. J-1 category. Choose the category that best fits the type of role the scholar will have at the U of M.

a. Primarily teaching, lecturing, and may conduct research and observe. (Minimum 3-week stay in the U.S.;maximum 5-year stay in the U.S.; subject to 24-Month Bar*)

Will this scholar’s program last more than 6 months, or is it likely to extend beyond 6 months?

b. Primarily conducting research and may also lecture and observe. (Minimum 3-week stay in the U.S.;maximum 5-year stay in the U.S.; subject to 24-Month Bar*)

Will this scholar’s program last more than 6 months, or is it likely to extend beyond 6 months?

c. Person with similar education to professor/research scholar coming for short-term visit primarily forresearch, lecturing, observing, training, or demonstrating special skills. (No minimum stay, but a maximum6-month stay in the U.S.; not possible to extend or change status; not subject to 24-Month Bar*).

*24-Month Bar is often confused with 2 Year Rule. See ISSS website or contact ISSS.

4. Is the scholar a physician or certified to practice medicine (M.D., veterinarian, dentist) in his orher home country? If yes, select a. or b.

a. The individual will at most attend or give lectures, go into patient areas observer or consultant, or work onresearch tissue and specimens that have no direct bearing on patient care.

b. The individual will be participating in a program of observation, consultation, teaching or research mayneed to have limited patient contact in order to carry out those objectives. The limited patient contact mustbe “incidental” to the programs objectives. Patient contact MUST NOT be connected to any clinical program(diagnosis and/or treatment). There must be NO element of patient care involved in the program and/or NOhands-on assistance during any clinical procedure.

*Request and attach Incidental Patient Contact Letter from Medical School (M.D.s) or Dean. See onlineinstructions.

No patient contact

Incidental patient contact with letter*

YesNo

SectIon 4: u of M prograM InforMatIon

YesNo, See c.

YesNo. See c.

Professor

Research Scholar

Short-Term Scholar

Day (DD)

Program Begin Date Program End Date7.Year (YYYY)Month (MM) Day (DD) Year (YYYY)Month (MM)

To allow reasonable time for the scholar to apply for and obtain his/her J-1 status, the Begin Date should be at least 2 months after this application is submitted. Ex. If you wish a scholar to begin Dec. 1st, then this application should be submitted no later than Oct. 1st.

Subject Field Category

Subject Field Code (xx.xxxx)

Subject Field Use the tables (http://isss.umn.edu/j/jFieldCode/) to fill in the code for the subject/field the scholar will be engaged in at U of M.

9.

Subject Field Code Description

Describe in one sentence, the primary project and activities in which the individual will be engaged (research in…, teaching, etc.)8.

Do not use this form for students whose primary purpose is to participate in a U of M degree or non-degree-seeking program. Please contact the Office of Admissions or ISSS regarding appropriate process.

International Student and Scholar ServicesUniversity of Minnesota

http://z.umn.edu/isssHelp 2 Updated 04/16/15

SectIon 5: u.S. preSence

10. Site of Activity. Indicate the scholar’s physical location(s) for scholar activities.

a.

b.

U of M hosting department.

U of M hosting department and an additional site. If more than one additional site, attach list on a separate sheet.

Additional Site of Activity Address

Additional Site of Activity Name

International Student and Scholar ServicesUniversity of Minnesota

12. Is the scholar currently in the U.S.?

If No, ISSS assumes they will use the U of M DS-2019 to enter the U.S. Skip to the next section.

If Yes, attach copies of current visa/status. Answer a.-e. as applicable:

a. Does the scholar plan to depart the U.S. prior to the start of this J-1 scholar program (then apply for J-1 visa at U.S. consulate abroad and return in J-1 status for this program)?

*If no, the scholar will need to submit a separate application to USCIS once this DS-2019 has been processed. USCIS takes ~3 months to process. More information about the Change of Status process is obtained from ISSS.

b. Is the scholar subject to the 2 Year Home Rule from a previous J-1 or J-2 status?

*If yes, the scholar MUST depart the U.S. prior to the start of this J-1 scholar program (then apply for J-1 visa at U.S. consulate abroad and return in J-1 status for this program).

c. Write their current U.S. visa/immigration status (e.g. B-1, F-1 OPT, H-1B):

d. If currently in J-1 or J-2 status, write current category found in Box 4 on their current DS-2019 (e.g. Research Scholar, Trainee)

e. Transfer. If currently in J-1 status as Research Scholar, Professor, or Short Term Scholar at another U.S. institution and requesting a J-1 transfer to U of M, attach copy of current DS-2019 and provide the following information:

YesNo

Current visa/immigration status

Current J category

YesNo*

Yes*No

Current Program Sponsor/School

Email

Responsible Officer/Alternate Responsible Officer Name

Phone Current DS-2019 End Date

No gaps! U of M start date cannot be after Current DS-2019 End Date. ISSS will contact the above person to arrange SEVIS transfer.

11.

a.

Has the scholar been in the U.S. in J-1 (any category) or J-2 status during the previous:

12 months? If yes, attach copies of previous DS-2019s.

b. 24 months? If yes, attach copies of previous DS-2019s.

YesNo

YesNo

http://z.umn.edu/isssHelp 3 Updated 04/16/15

SectIon 6: dependentS

Current Email (if one exists)

DepenDent 1

Current Email (if one exists)

DepenDent 2

Current Email (if one exists)

DepenDent 3

ChildSpouse

ChildSpouse

ChildSpouse

If the scholar wishes to invite dependents (children under the age of 21 or a spouse) in J-2 status, please complete the information below for each dependent. (Note: J-2 dependents are not allowed to enter the U.S. before the J-1’s initial entry.)

International Student and Scholar ServicesUniversity of Minnesota

U of M ID (Provided by department)

Date of Birth (mm/dd/yyyy)

Gender

Passport Given Name(s)Passport Surname(s)

City of Birth

Country of Legal Permanent ResidenceCountry of Citizenship

Preferred Name(s) optional

Country of Birth

U of M ID (Provided by department)

Date of Birth (mm/dd/yyyy)

Gender

Passport Given Name(s)Passport Surname(s)

City of Birth

Country of Legal Permanent ResidenceCountry of Citizenship

Preferred Name(s) optional

Country of Birth

U of M ID (Provided by department)

Date of Birth (mm/dd/yyyy)

Gender

Passport Given Name(s)Passport Surname(s)

City of Birth

Country of Legal Permanent ResidenceCountry of Citizenship

Preferred Name(s) optional

Country of Birth

http://z.umn.edu/isssHelp 4 Updated 04/16/15

SectIon 7: fInancIal Support

Funding Source

1st Year 2nd Year (if applicable)

3rd Year(if applicable)

4th Year(if applicable)

5th Year(if applicable)

Total in US$

U of M

U.S. government agency

International organization

Exchange visitor’s government

Binational commission of the exchange visitor’s countryAll other universities or organizations

Personal Funds

Total in US$

Name:

Name:

Name:

Has the U of M received funding from the U.S. government specifically for the purpose of international ed-ucational exchange for this applicant (this does not include government grants given to the U of M directly, other than for the specific purpose of exchange)?

YesNo

If yes, please specify:

Minimum funding requirements*:

For Per Month Per Year

J-1 Scholar $1,300 $15,600

Additional funds are required if scholar is inviting J-2 dependents:

1 dependent $691 $8,292

2 dependents $971 $11,652

3 dependents $1,196 $14,352*Minimum considers cost of basic accomodations, utilities, food,

transportation, & health insurance. Planning for more is recommended.

Indicate in the chart below all sources of funding for the period requested in this application based on the minimum funding requirements. Attach copies of documentation to verify funding indicated in chart (ex. offer letter, scholarship letter, bank statement).

International Student and Scholar ServicesUniversity of Minnesota

Documentation should be in US$ or include currency conversion. It should be in English or have an unofficial English translation attached.

U of M Offer Letters: If the dates in this request do not match the initial offer dates in your letter, a statement should be added in/with the letter that the department requests the DS-2019 to be issued for the dates matching in this request.

Funding ranges: If a funding letter provides a range of support, the lower amount is to be used for this request.

http://z.umn.edu/isssHelp 5 Updated 04/16/15

We understand that the primary purpose of the J Exchange Visitor Program is not to provide employment, but to foster the exchange of ideas between Americans and foreign nationals and to stimulate international collaborative teaching and research efforts.

We understand that the exchange of scholars promotes mutual enrichment and linkages between research and educational institutions in the United States and foreign countries. It does so by providing foreign scholars the opportunity to engage in research, teaching and lecturing with their American colleagues, to participate actively in cross-cultural activities with Americans, and ultimately to share with their fellow citizens their experiences and increased knowledge about the United States and their substantive fields.

We understand that J-1 Research Scholars’ primary activity must be conducting research; J-1 Professors’ primary activity must be lecturing; J-1 Short Term Scholars’ primary activity must be conducting research, lecturing, observing, consulting, training, or demonstrating special skills.

Our department is inviting this individual for the period indicated.

If our department will be funding the scholar, we verify that the information is accurate in the application materials.

We understand that the scholar and their dependents are required to carry health insurance for the duration of their stay. The U of M requires all of its J visa holders to enroll in the University-sponsored health insurance or comply with the requirement otherwise through the Office of Student Health Benefits.

If this scholar is requesting to transfer to the U of M from another J Program Sponsor in the U.S., we confirm that this will be a continuation of their original program. This means that the scholar’s program objectives at the U of M will be consistent with the individual’s original program objectives for which they were initially invited to the U.S. to complete.

The faculty mentor indicated below agrees to abide by the “Faculty Mentor Responsibilities” found on our website.

A signature for both positions below are required.

SectIon 8: u of M departMent SIgnatureS

International Student and Scholar ServicesUniversity of Minnesota

Title

Print Name

Email

Phone

DateSignature of U of M Faculty Mentor

Title

Print Name

Email

Phone

DateSignature of U of M Department Head

This form is in support of [Scholar Surname] Scholar U of M ID[Scholar Given Name]

http://z.umn.edu/isssHelp 6 Updated 04/16/15

INTERNATIONAL STUDENT & SCHOLAR SERVICES, U of MN 190 Humphrey School, 301-19th Ave. South

Minneapolis, MN 55455, U.S.A.

UNIVERSITY OF MINNESOTAInternational Student and Scholar Services 190 Hubert Humphrey School Global Programs and Strategy Alliance 301-19th Avenue SouthUniversity of Minnesota Minneapolis, MN 55455

Tel.: 612-626-7100Fax: 612-626-7361

J SCHOLAR ADMINISTRATIVE FEE FORM

The U of MN hosting department must provide the following information for budget purposes. Please include this form with visa request document. ALL THE FIELDS IN BOLD ARE REQUIRED (without this information, our office will NOT be able to PROCESS THE APPLICATION.

Name of Exchange Visitor EMPLID___________________

NAME OF FACULTY REQUESTING DS-2019 ______________________________ Email______________________

Phone_____________________

Non-sponsored Account String Fund _ _ _ _ DeptID _ _ _ _ Program _ _ _ _ _ _ Acct 720399

(OPTIONAL) CF1 _ _ _ _ _ _ _ _ _ _ CF2 _ _ _ _ _ _ _ _ _ _

FinEmplID _ _ _ _ _ _ _ _ Cost Share _ _

Department Name ___________________________________________________________________

Department Address ___________________________________________________________________

___________________________________________________________________

Budget Contact Person ___________________________________________________________________

Phone _________________________ Fax Email ___________________

FOR GPS Alliance USE ONLY

___________ J-1 $310 Date Sent to GPS ____________

http://z.umn.edu/isssHelp 7 Updated 04/16/15

INTERNATIONAL STUDENT & SCHOLAR SERVICES • 190 Humphrey, 301 – 19th Avenue S, Minneapolis, MN 55455 U.S.A. (612) 626-7100 • Fax (612) 626-7361 • isss@umn.edu • www.isss.umn.edu

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STATEMENT OF RESPONSIBILITIESFOR NEW J-1 RESEARCH SCHOLARS, SHORT-TERM SCHOLARS,

PROFESSORS AND STUDENT-INTERNS

Please read and sign the bottom of the next page. Keep a copy for your records. You may scan and send the signed form to your hosting department. Please contact your department or ISSS if you have questions about any of the information below.

1. Maintain accurate visa documents. Your official government documents must be accurate and valid at all times. Contact ISSS toupdate any information on your DS-2019 (i.e. funding) or DS-7002 (Student-Intern only; i.e. funding, enrolling in a class).

Name consistency: Your name should appear exactly the same as it is on your passport and should be consistent on all of your official documents in the U.S. The documents are:

• Immigration documents (DS-2019, I-94 Arrival/Departure card or record)• Payroll documents - if applicable (U.S. Social Security card, U of M Payroll I-9 Form)• Other identification documents - if applicable (Minnesota driver’s license or state I.D. card)

2. Report your arrival and residential address: You must arrive and report to ISSS within 25 days of your DS-2019 start date. At thattime you will also need to report your U.S. residential address. You must report subsequent residential address changes within 10 days ofmoving while you are in J-1 status. You must alert your hosting department and ISSS if you are unable to meet the reporting requirement.

3. Report your e-mail address: You must always have an active e-mail address that the University can use to contact you. Keep yourhosting department and ISSS updated with your email information.

4. Health insurance requirement: Research Scholars, Short-term Scholars and Professors: If the length of your program is 31days or more, U of M requires that you (and any eligible J-2 dependents) purchase the U of M health insurance. J-1 scholars,and all J-1 Student-Interns regardless of program duration, are required to have either the University Employee Benefits HealthInsurance, if employed by the U of M, or the University Student Health Benefit Plan (SHBP), if not employed by the U of M. Formore information, visit the Office of Student Health Benefits website: http://shb.umn.edu/health-plans/gahp-home

If you do not purchase the U of M insurance for yourself and your dependent(s), for the entire length of your J program, you will not be eligible for ISSS services after you arrive. These services include:

• Travel/Reentry Signature• DS-2019 Extension• Dependent DS-2019 Request• Financial Update• Occasional Lecture and Short-term Consultation Authorization

Failure to purchase any health insurance for the duration of your J program will result in ISSS terminating your J status, because J-1 Exchange Visitors and their dependents are required by the U.S. Department of State to carry health insurance in order to maintain their status. For more information, visit our J Health Insurance page: isss.umn.edu/j/insurance.html

5. Engage in appropriate activities: You may participate in the specific program or purpose for which your department invited you. Otheractivities (including enrolling in classes) must be approved by your faculty mentor in your hosting U of M department and by an ISSS J-1adviser. You must have the approval from your hosting department to audit any courses.

Scholars:

You are only authorized to be enrolled in classes part-time, and only as long as they do not interfere in with your J-1 program. You must maintain full-time focus on the scholar activities you were invited to do.

Student-Interns:

You must maintain full-time focus on the activities as listed on the DS-7002, including enrolling in classes. If your activities will vary from the description on the DS-7002, your hosting department must contact ISSS before you engage in any new activities.

6. Work only with appropriate authorization: You are only authorized to work in your U of M hosting department for the activities you havebeen invited to do. Other employment or payment either at the U of M or off-campus must be authorized by your faculty mentor and ISSS.

7. Have and maintain your funding: You are required to have and maintain enough funding to cover the minimum expenses as outlinedin the ISSS Scholar or Student-Intern application for yourself and any J-2 dependents for the duration of your J program. ISSS applications’minimum cost of living is very low. You and your family’s actual expenses can vary quite a bit depending on where you decide to live,whether you make your own meals or not, transportation costs, etc. It is strongly advised that you plan your finances accordingly to haveaccess to more funding than the minimums stated on the application.

INTERNATIONAL STUDENT & SCHOLAR SERVICES • 190 Humphrey, 301 – 19th Avenue S, Minneapolis, MN 55455 U.S.A. (612) 626-7100 • Fax (612) 626-7361 • isss@umn.edu • www.isss.umn.edu

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8. Request ISSS authorization to transfer: You must receive approval from ISSS to change from your current U of M hosting departmentto another department within the University, or to transfer to another institution within the U.S.

9. End of Program: Your J SEVIS record will automatically complete after the end date on your DS-2019. If you will complete yourprogram with us as expected, there are no additional steps for you to take regarding your visa status. However, if you will be unable or donot intend to return home within the allotted Grace Period (see below), you must discuss your plans with an ISSS adviser to ensure thatyou maintain legal status in the U.S. Also, if you complete or end your program more than 15 days before the end date of your DS-2019,you must notify ISSS.

10. Comply with the 30 Day Grace Period: J-1 visa holders are given a 30 day “grace period” after the end date of their J-1 program toprepare for departure and/or to travel within the U.S. The program end date is usually the end date on your DS-2019. However, if you donot continue your original J-1 program until the DS-2019 end date, your program (U of MN J-1status) ends on the date you complete yourJ-1 original activity, transfer to another J-1 sponsor, or change your visa type.

11. J-2 Dependents:

• Report your J-2 dependents’ email addresses (if applicable) upon their arrival in the U.S.• J-2s may enroll for courses without additional authorization.• J-2s may work only after receiving employment authorization from the USCIS. J-2 income cannot become the primary source of funding

for J-1s or J-2s.• J-2s are not allowed to remain in the U.S. after you have completed your J-1 program and have left the U.S.• Report to ISSS if a J-2 dependent will not use a DS-2019 they were issued• If your J-2 dependents leave permanently before your end date, report their departure to ISSS to end their J-2 SEVIS record

For more information: isss.umn.edu/j/j2visa.html

12. Release of Information: Your records and other information resulting from any services you may receive from ISSS are private and will ordinarily not be released without your prior written consent. However, the information may be shared within ISSS or with other University offices on a need to know basis. In addition, state and federal laws place some limits on confidentiality and may require ISSS to share information, without your permission, with other offices.

We are required to share information with the appropriate University or government offices if you discuss with us:

• An imminent and credible threat of harm to yourself or another person• An incident of sexual assault, sexual harassment, relationship violence, or stalking that occurred on campus, occurred during a University

program or activity, or was committed by a University student or employee.• Any physical abuse, neglect or sexual abuse of children or vulnerable adults within the last three years (including abuse of you if you

were under the age of 18 at the time)• As required by the Department of Homeland Security or other U.S. government agencies who may be designated to request information.

For more information, please see our website isss.umn.edu/advising/confidentialitylimits.

13. Use of Public Funding: As a nonimmigrant, you are not eligible to use any type of public funding during your stay in the U.S.

14. You must file a U.S. Income Tax form: By April 15 each year, even if you have not earned any income in the U.S. ISSS providesresources for tax assistance but does not offer any tax advising.

15. Travel: If you are travelling outside of the U.S., you must ensure you have the proper documents needed to re-enter: valid passport,valid entry visa stamp in your passport, valid DS-2019 with a valid ISSS re-entry signature (lower right corner), proof of funding indicatedon your DS-2019, and proof of health insurance. For more information: www.isss.umn.edu/j/Jtravel.html.

STATEMENT: I have carefully read these responsibilities and understand their importance. I am aware that my legal status in the U.S. depends on fulfilling these responsibilities to the best of my ability. If I have any questions at any time about these matters, I know that I may contact ISSS.

Signature Month/Day/Year

Print Name U of M ID Number

Measurement Type Options & Instructions SelectedA. English Language Test Test must have been taken within the last 5

years.

To take a test: the applicant must go directly to a test’s online information and registration, then follow test-specific instructions to take the test.

Include a copy of the applicant’s score(s) with the ISSS application materials. (Only one test from the right is needed.)

Test Name Minimum Score

1. Cambridge ESOL B2

2. IELTS Academic, General 5.5

3. MELAB 64

4. MN Battery Test 64

5. OPI / OPIc Intermediate-Low

6. TOEFL iBT 53

7. TOEFL PBT 477

8. TOEIC (Listening/Reading) 500

9. TOEIC (Speaking) 130

Chinese-specific Tests

10. PETS5

11. Pre-departure Training Department Advanced EnglishTraining Program Certificate

B. U of M MELP Interview Departments and scholars wanting to schedule a proficiency interview should contact MELP (Minnesota English Language Program) at esl@umn.edu or 612-624-1503. Interviews are done via Skype or telephone. The overall oral proficiency rating is reported to the hosting department. MELP will charge a $75 fee to the department.

Include a copy of the MELP report with the ISSS application materials.

(Intermediate-Low Level minimum)

Date interview was completed (mm/dd/yyyy):

C. Native English Speaker Country of citizenship must be one of the countries listed below

D. Diploma Applicants who have completed a bachelor’s or graduate degree within the past 10 years in residence at a recognized institution of higher learning in the U.S. or a country listed to the right may use this option.

Include a copy of applicant’s diploma with the ISSS application materials.

AnguillaAntigua and BarbudaAustraliaBahamasBarbadosBermudaBritish Virgin IslandsCanada (except Quebec)Cayman IslandsDominicaEnglandFederated States of MicronesiaGrenadaGuyana

IrelandJamaicaMonserratNew ZealandNorthern IrelandScotlandShetland IslandsSt. Kitts-NevisSt. LuciaSt. Vincent and the GrenadinesTrinidad and TobagoTurks and Caicos IslandsWales

U.S. Territories including…American SamoaGuamMarshall IslandsNorthern Mariana Islands

PalauPuerto RicoVirgin Islands

ENGLISH PROFICIENCY FORMFOR PROSPECTIVE J-1 RESEARCH SCHOLARS, PROFESSORS,

SHORT TERM SCHOLARS, AND STUDENT-INTERNSAs of January 5th, 2015, all J-1 applicants are required by the U.S. government to fulfill a measurement of English language proficiency. • J-1 Scholars (Research Scholars, Professors, and Short Term Scholars): Departments should include this form with the ISSS Prospective J-1

Scholar application.• J-1 Student-Interns: Departments should include this form with the ISSS Prospective Student-Intern Eligibility form and DS-7002 (TIPP or

Internship Plan). NOTE: If the Internship Plan includes a requirement to register for a UMN class for credit, the Student-Intern will be required tomeet the English Proficiency standard for UMN admission (e.g., 79 on the TOEFL iBT).

Select the measurement type that applies to the prospective J-1 Scholar or Student-Intern and follow the respective instructions. Other cases that will be considered are listed on the following page.

1This form is in support of [Individual’s Surname] [Individual’s Given Name] Individual’s U of M ID

Please include any notes of clarification you think would be helpful for ISSS to know below or on a separate sheet of paper.

Cases for Consideration

Upon the hosting department’s request, the below cases will be taken into consideration and reviewed in place of an English Language Test or U of M MELP Interview (options A. and B. from previous page). Acceptance is not guaranteed. If the materials submitted are deemed unsatisfactory to fulfill the English Proficiency Requirement, ISSS will require the scholar to submit results from option A. or B. from the previous page (English Language Test or U of M MELP Interview).

Current/Recent Presence in the U.S. and J-1 Transfers

I’ve been present in the U.S. for the past year in J-1/ H-1B/ F-1 status. How do I fulfill therequirement?

A letter, written by the U of M faculty mentor or department head, will need to address the applicant’s English proficiency and list any/all past professional or academic activities/projects done by the applicant in English that would demonstrate their English proficiency (i.e. teaching at a U.S. university in English). This letter must also include how long the applicant has already been in the U.S. as a scholar/ staff/ or student. Please submit to ISSS (isssjast@umn.edu), and the case will be reviewed. After review and consultation, ISSS will inform the department if the letter can or cannot be accepted to fulfill the Requirement.

Near-Native English

I have a near-native proficiency in English, but am not a native English speaker and I do not have a degree from an English-speaking university. Is there another way for me to fulfill the Requirement?

A letter, written by the U of M faculty mentor or department head, will need to address the applicant’s English proficiency and list any/all past professional or academic activities/projects done by the applicant in English that would demonstrate their English proficiency (i.e. teaching at a U.S. university in English). The letter should be accompanied by materials to better support the case. Please submit to ISSS (isssjast@umn.edu), and the case will be reviewed. After review and consultation, ISSS will inform the department if the letter can or cannot be accepted to fulfill the Requirement.

Insufficient Score

I had an oral interview with the U of M Minnesota English Language Program (MELP), which is one of the options on your form. I did not receive a passing score. What are my options now?

Please contact ISSS (isssjast@umn.edu) about this. The applicant will be given the option to take a specific part-time MELP English course after arrival for their J-1 program. If the applicant and the hosting department agree to the course option and the applicant has sufficient funding to cover the tuition and fees for the course, ISSS can accept this and continue processing a DS-2019 for you.

Note: This option can only be offered after an applicant has already submitted results from option A. or B. from the previous page.

INTERNATIONAL STUDENT & SCHOLAR SERVICES • 190 Humphrey, 301 – 19th Avenue S, Minneapolis, MN 55455 U.S.A. (612) 626-7100 • Fax (612) 626-7361 • isss@umn.edu • isss.umn.edu

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