J-1 Personal Information Form

 
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This form is be completed by the prospective exchange visitor

Instructions

Please fill out this form and prepare the following documentation to submit at the end of the application.

  • Curriculum Vitae
  • Copy of passport picture page, as well as the passport of any dependents that will be traveling with you to the U.S.
  • Financial documentation (in English and no older than 6 months from date of submission)
  • Certified copy of academic degree
  • A personal statement identifying the reasons to leave the U.S. after program completion


Who is your sponsoring department at Cal Poly Humboldt?
Please include the first and last name of the faculty member who is sponsoring your exchange.
Part 1: Personal Information
Name should appear exactly as on your passport.
Cannot be a PO box.
If different than permanent address.

J-1 exchange visitors must demonstrate sufficient funds to cover the estimated expenses associated with their exchange program. To find the current estimates that International Programs at the College of Extended Education & Global Engagement (CEEGE) uses for DS-2019 issuance, please review the International Programs/CEEGE website.

Please use the questions below to outline your funding sources and to help you determine the amount you must demonstrate in personal funds or from a personal sponsor, if any. Official documentation for each source must be provided. This means all letters must on official letterhead, bank letters or statements can be no older than 6 months and must be in English. Documentation should be uploaded at the bottom of this form.

Part 2: Financial Information
List the amount provided by Cal Poly Humboldt.
List the amount provided by the U.S. Government.
List the amount provided by visitor's government.
List the amount provided by other sources.
List the amount provided by personal funds.
Please list the total funding based on the amounts above.
Part 3: Dependent Information
If dependent is your spouse, please provide copy of marriage certificate.
Files must be less than 50 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.
Files must be less than 50 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.
Files must be less than 50 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.
Files must be less than 50 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.
Files must be less than 50 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.
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