DS-2019 Request Form

Part 1: Department Information
Part 2: Visiting Faculty/Staff (Exchange Visitor) Information
Provide the name of the agency that has supplied your funding.
Provide the amount of funding supplied by this agency.
Provide the amount of funding supplied by HSU
What is the type of funding? (e.g., grant/stipend)
Provide the source of the funding.
Provide the amount of this funding.
Please provide a detailed description of the exchange visitor's program activity, including proposed teaching/research project, cultural programming, and expectation of results.
Part 3: English Language Proficiency
Has the exchange visitor demonstrated English language proficiency? English language proficiency can be demonstrated by meeting the undergraduate language requirements.
Does the exchange visitor have signed documentation attesting to English language proficiency? English language proficiency can be shown by providing information from a U.S. or foreign institution where English is the/an official language in the form of a letter or official transcript from an accredited college or university verifying either full time enrollment in a post-secondary degree program or completion of a degree program (e.g., a bachelor’s degree).
Has an interview been conducted with the exchange visitor? The interview can be conducted in-person, by video-conferencing (e.g., Skype), or by telephone. Please complete the below Interview Verification Form following the interview.
Part 4: Checklist of Sponsor's Responsibilities
Please click the checkbox below to electronically sign this form.
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