J-1 Application Form (Participant)

* Required Fields

If you have any questions about this form or the J-1 Visitor program, please contact Pamela Redmond at predmond@wakehealth.edu.

Form Instructions

Please fill out the form as completely and accurately as possible. 

Note: All financial information must be gathered before filling out this form. Your DS2019 cannot be processed without numerical financial information. 

Passport Information

Please email a copy of your passport data page to Pamela Redmond at predmond@wakehealth.edu

 Surname*

   

 Please  input all names listed in the "Surname" field of your passport, exactly as they are written in your passport.

Given Name(s)*

   

Please input all names listed in the "Given Name(s)" field of your passport, exactly as they are listed.

Gender* 

                        

Current Mailing Address

Street Address*   

City* 

State/Province/Region* 

Country* 

ZIP/Postal Code* 

Permanent Foreign Address (if different from above)

Street Address   

City 

State/Province/Region 

ZIP/Postal Code 

Country 

Email* 

Phone* 

Date of Birth (MM/DD/YYYY)* 

City of Birth* 

Country of Birth* 

Country of Permanent Residency* 

Country of Citizenship* 

Title of current position in home country*   

(e.g., undergraduate student, graduate student, professor, doctor, etc.)

Nature of employer   

(e.g., national government, local government, nonprofit, private industry, etc.)

Estimated start date of J-1 program (MM/DD/YYYY)* 

Estimated end date of J-1 program (MM/DD/YYYY)* 

J-1 category

Explanation of J-1 categories: 

  • Student Masters: Exchange visitor who will enrolled on a full-time basis in the Bowman Gray M.S. program. (Maximum time: No set time; exchange visitor allowed to remain in U.S. until degree is obtained)
  • Student Doctorate: Exchange visitor who will be enrolled on a full-time basis in the Bowman Gray Ph.D. program. (Maximum time: No set time; exchange visitor allowed to remain in U.S. until degree is obtained)
  • Research Scholar: Exchange visitor coming to WFUHS to conduct research, learn new techniques, etc., whose program will last longer than six months. (Maximum time: 5 years)
  • Short-term Scholar: Exchange visitor coming to WFUHS to conduct research, observe, learn new techniques, etc., whose program will not last longer than 6 months. 

Important: Please be aware of the fact that a short-term scholar program cannot be extended beyond 6 months. If you feel that there is even a slight chance that your program will go beyond 6 months, please select the "Research Scholar" category.

Department at WFU Health Sciences that has agreed to sponsor you for your J-1 program  

Name of contact person in sponsoring department  

Please provide a brief description/summary of the research activities you will be conducting at WFUHS*

   

English Proficiency

I have demonstrated my proficiency in English...

    

Please email appropriate documentation providing evidence of English proficiency to Pamela Redmond at predmond@wakehealth.edu.

Funding Information

Note: It is necessary that you provide a monetary amount for the funding information of your program. Please be sure to inquire with WFU Health Sciences and/or other organizations to find out what types of financial support you will have available to you prior to filling out this form. If you will not be receiving financial support from WFU or an external organization, please list $1500.00/month and state that you will be funding yourself under "Names of organization(s) other than WFUHS that will provide funding."

This amount can be an estimate. Please list in U.S. dollars ($).

It will not be possible to process the DS-2019 form without an estimate of the amount of finances that you will be receiving either from Wake Forest or an external organization.

Total amount of financial funding/benefits provided by Wake Forest University Health Sciences

Total amount for food, housing, scholarship, etc. Must be a numerical dollar amount (example: $3000.00). Enter $0 if you will not be receiving any money from WFUHS.

Financial support coming from other source(s) 

Total amount of funding from outside organizations. Do not include amounts from Wake Forest University Health Sciences. Must be a numerical dollar amount (example: $3000.00)

Email proof of funding to Pamela Redmond, predmond@wakehealth.edu.

If you will be funding yourself or will be funded by family, please indicate at least $1500.00/month and indicate "personal savings" or "family savings." 

Name(s) of organization(s) other than WFUHS that will provide funding

 

Additional funding information/comments

Within the past 24 months, have you been physically present in the U.S. in either the J-1 or J-2 category as a professor or research scholar for a period of 6 months or longer? (Does not apply to the short-term scholar category.)

               

 If yes, please explain.  

          

Dependent Information

How many dependents will accompany you?*

 

If dependents will accompany you, please provide information for each.

 

Quick Reference

Pamela Redmond
Immigration Specialist

336-716-1194

predmond@wakehealth.edu

Hours
M-F, 10 am - 5 pm
Office of International Services
Wake Forest Baptist Medical Center
Medical Center Blvd.
Winston-Salem, NC 27407
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