Office of the Under Secretary of Defense for Acquisition, Technology & Logistics

DEPARTMENT OF DEFENSE

OFFICE OF THE UNDER SECRETARY OF DEFENSE FOR ACQUISITION, TECHNOLOGY & LOGISTICS

ACQUISITION RESOURCES & ANALYSIS

Application for Consideration of Waiver

of the Two-Year Foreign Residence Requirement

of the Exchange Visitor Program

(Please complete or use as a model; type or print. If additional space is needed, use plain bond paper and refer to each item number.)

______

Date

I. APPLYING INSTITUTION

1. Name and Location of Applying Institution (if not a Defense Agency or Laboratory, also list Defense Office(s) responsible for research):

2. Name and telephone number of responsible official:

II. INDIVIDUAL FOR WHOM WAIVER IS REQUESTED

3. Name:

4. Maiden Name (if married):

5. Date and Place of Birth:

6. Nationality:

7. Alien Registration Number:

8. Date of Visa Expiration:

9. Exchange program affiliation and number (if more than one, list all programs):

10. Was exchange visit supported by U.S. and/or own government funds? If so, please explain (include approximate amount involved).

11. Address of Immigration and Naturalization Service Office:

12. Has individual or employer filed third (spouse or child) or sixth preference (individual has a petition that indicates he has a prospective employer and the validity has been certified) visa petition (INS Form I-140)? If so, where and when?

13.

U.S. ENTRIES / U.S. DEPARTURES /
DATE / PLACE / TYPE OF VISA / DATE / PLACE

14. Country of last foreign residence before U.S. admission:

15. Occupation:

16. Major field or activity (i.e., education, engineering, natural and physical sciences):

17. Education and professional training (college, postgraduate, other):

Name & Location of Institution / Dates Attended / Degree(s)

18. Experience (start with current assignment and work backward):

Name & Location of Institution / Dates Attended / Degree(s)

19. List significant publications:

20. Family (if married, list dependents):

Name(s) / Date of Birth / Place of Birth / Nationality/Visa Status
Spouse:
Children:

21. Present home address:

22. Present office address:

23. Has waiver application been applied for in any other Federal Agency? If so, the date and results are to be provided; use plain bond paper if explanation of denial would be relevant to this review.

24. Has concurrence to proposed waiver been secured from Exchange Visitor Program Sponsor? Please attach Exchange Program official’s comments if available.

25. When both husband and wife are exchange visitors in their own right (i.e., each has J-1 exchange visa status), a separate application should be completed for each.

III. BASIS FOR WAIVER APPLICATION

26. Please present, in an accompanying letter, a description of the individual’s special qualifications and experience for contributing to programs of official interest to the Department of Defense in terms of criteria and considerations set forth in the Defense policy and procedures statement. Where applicable, identify contracts or grants by title, number, source, and responsible contracting official.

27. Copies of all [DS2019 forms or formally IAP-66 forms] must be included.

28. Copy of DS 3035 form and notification of Department of State Waiver case number.

29. Submit documentary evidence that an attempt was made to recruit U.S. citizens for this project to include advertising media used, how many individuals applied, and why the recipient was the best qualified applicant. Provide data as to the stipend/salary offered, if any.

30. Provide rationale as to why the applicant was selected and permitted to become the most important member of the research team, knowing that he/she was required by law to return to his/her home country after completion of studies and expiration of the J-1 visa.

31. Provide a statement that the transfer of critical technology to a foreign nation was considered when selecting the applicant as a member of a government-sponsored project that the sponsoring agency now considers vital to the defense of the U.S.

32. Please provide a brief description of the future professional plans of the applicant, including type and location of future training and/or employment.

Prepared by:

______

Type name, address and phone number

Mail form to:

Office of the Under Secretary of Defense

(Acquisition, Technology & Logistics)

ATTN: Mr. Drew Setterberg, Acquisition Resources & Analysis

Room 3C949A, Pentagon

3020 Defense

Washington, DC 20301-3020

* Prefer package be Federal Expressed to avoid damage or delays during handling in the Department of Defense mail system.

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