J-1 Information

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In order to apply for a J-1 visa, you need a Certificate of Eligibility for Exchange Visitor (J-1 status), or DS-2019. The International Studies Office (ISO) will prepare a DS-2019 with directions for its use in applying for a J-1 visa. In order to get the DS-2019, the Center for Global Health needs the following information from you. If there is a mistake or other incorrect information, this can delay your visa.

Last Name (Exactly as it appears on your passport)*

First Name (Exactly as it appears on your passport)*

Gender*

M F

Date of Birth (MM/DD/YYYY*

City of birth*

Country of birth*

Country of legal permanent residence*

Country of citizenship*

Position and/or title in country of legal permanent residence*

In the field provided, please upload a copy of your most recent Curriculum Vitae (CV).*

In the field below, please upload a one (1) page planned research summary including title, background, objectives, methods, expected output and timetable of actvitities. This is intended to be a brief abstract for use in obtaining your visa.*

The date you plan to come to the US to begin your fellowship*

The date that you plan to leave*

Email Address*

If you plan to bring any family members with you, they will need to have a J-2 visa. Please complete the following information for all J-2 dependents. Email required info on additional family members to alb2b@virginia.edu

First Name

Last Name

Country of birth

Country of legal permanent residence

Country of citizenship

Date of Birth MM/DD/YYYY

Gender

M F

Relation to J-1 visitor:

Spouse Child

Home Country Address

Medical information in case of emergency (i.e. allergies, diabetes, etc.)*

Emergency Contact in your home country. Whom should we notifiy in the event of an accident or problem? Please provide email, address and telephone (with country and city code).*

University of Virginia Health System