This form must be submitted by J1 Exchange Visitors immediately after arrival in the U.S. and, under no circumstances, later than the 15th day after the program start date noted on the DS-2019.
J2 dependents should NOT submit this form as the arrival of a J2 is not required to be confirmed.
This form must not be submitted before the Exchange Visitor's arrival in the U.S. If the Exchange Visitor cannot arrive and report arrival by the 15th day after the program start date as noted on the DS-2019, the Exchange Visitor should contact their department administrator immediately so that the program start date can be revised.
• If the Exchange Visitor has applied for a Change of Status in the U.S., this form must be submitted no later than 15 days after the effective date on the Change of Status Approval Notice (I-797), or by the 15th day after the program date on the DS-2019, whichever is earlier.
• If the Exchange Visitor is transferring from another J sponsor, this form must be submitted upon arrival at Stanford.
• If the Exchange Visitor's program is shorter than 15 days, this form must be submitted after arrival, prior to the program end date on the DS-2019 and before the Exchange Visitor departs from the U.S.
Failure to submit this form within the time frame indicated above will result in termination of the J1 Exchange Visitor's program.
* indicates required fields.
This is the 11-digit sequence located on the upper right corner of your DS-2019 and begins with 'N'
SEVIS Number (begins with 'N', e.g. N000123456789) *
Surname (Family name) as shown on the DS-2019 *
Given names (all) as shown on the DS-2019 *
Phone (e.g. 650-555-1212) If you do not have a US phone number, please submit the phone number of your current Stanford department *
This address may be temporary. NO Stanford office addresses, please. Please enter the NUMBER of your street address first in the Street Address field followed by the NAME of the street after the number. Please check your address before entering it to make sure it conforms to the standardized version of the address in the USPS system: https://tools.usps.com/go/ZipLookupAction!input.action
Street Address *
Zip Code *
- If you entered the U.S. under Stanford's J sponsorship, note your date of arrival in the U.S.
- If you transferred from another J sponsor to Stanford's J sponsorship, note your date of arrival at Stanford under Stanford's J sponsorship.
- If you applied for a change of status to J within the U.S., note your date of arrival as the effective date on I-797 Approval Notice or the 15th day after the program start date on the DS-2019, whichever date is earlier.
Note date as Month/Day/Year *
All J Exchange Visitors and their J2 dependents are required to have medical insurance that meets the U.S. State Department's specifications while they are in the U.S. in J status.
Insurance coverage must be maintained during the entire duration of the J program.
Name of the insurance provider (insurance company or government plan--this is REQUIRED) *
By submission of this form, I confirm that I understand my failure to comply with the U.S. State Department's J insurance requirement for myself and my J2 dependents will result in termination of my J program.
After clicking the 'SUBMIT' button, you will be re-directed to a web page with further instructions and important information.>
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