DS-2019 REQUEST FORM FOR J-1 STUDENTS
If you are a J-1 international student and you need a new DS-2019, please complete this form. If there has been a change to your program, personal, or funding information, you will need to complete this form so we can update your SEVIS record and issue you a new DS-2019 if necessary. These changes must be reported to our office within 10 days.Please return this form to the International Student Advisor, Office of International Education, Suite 103, Carole Weinstein International Center. Please allow 5 days to process your request. We will email you when your new DS-2019 is available for pick up in the Resource Center, 1st floor, Carole Weinstein International Center.
We will accept and process these forms throughout the semester, but the last possible date to submit this form is May 1st for the spring semester and December 1 for the fall semester. Forms submitted after these dates will not be processed, which may affect your ability to travel outside the U.S. Exceptions will be considered for unforeseen circumstances – please make an appointment with the International Student Advisor to discuss this.
A. Student Information Section
FAMILY NAMEGIVEN NAME UR ID
CAMPUS ADDRESSCAMPUS TELEPHONE
EMAIL ADDRESSACADEMIC MAJOR
SEVIS ID N00DATE OF BIRTH CITIZENSHIP
(mm/dd/yyyy)
B. Please check off one or more boxes below and complete all information with required documentation. Incomplete sections will cause a delay in processing your request.
DS-2019 is lost and I need a replacement.
DS-2019 is stolen and I need a replacement.
DS-2019 is damaged and I need a replacement.
All of the signature lines for travel are full and I need a new signed page for travel.
There has been a change to my program information and I need an updated DS-2019 for the following reasons(please attach documentation of these changes, such as Bannerweb or Registrar's report indicating new major, new graduation date, etc).
Change in major - Current major(s)New Major(s)
Change in program start date - Current start dateNew start date
(mm/dd/yyyy) (mm/dd/yyyy)
Change in program end date - Current end dateNew end date
(mm/dd/yyyy) (mm/dd/yyyy)
Other (please explain):
NOTE: If your program start and/or end dates have changed, please also complete one of the checkboxes on Page 2 for early or delayed completion.
There has been a change to my personal information and I need an updated DS-2019 for the following reasons (please attach documentation of these changes, such as marriage certificate indicating new name, copy of passport indicating new citizenship, etc):
Change in name - Current Family Name New Family Name
Change in name - Current Given Name New Given Name
Change in Citizenship - Current Citizenship New Citizenship
Change in Legal Permanent Residence - Current Country New Country
Change in Foreign Address - Current Foreign Address
New Foreign Address
There has been a change in my U.S. Address (within 10 days of the change, please also complete
form AR-11, which is available online at:
Current U.S. AddressNew U.S. Address
There has been a change in my U.S. phone number
Current U.S. phone number New U.S. phone number
There has been a change to my fundinginformation and I need an updated DS-2019 for the following reasons (Do NOT complete this section if there is no substantial change to your funding since tuition, room, board, and other fees change each year.Please attach documentation of these changes, such as a letter from the U.S. or home country government, academic institution, program sponsor, or international organization):
Change in funding - Source Current Amount$ New Amount$
Change in funding - Source Current Amount $ New Amount $
Change in funding - Source Current Amount $ New Amount $
Change in UR scholarship amount - Current Amount$ New Amount$
Name of UR scholarship
Change in student's personal funds - Current Amount$ New Amount$
I am withdrawing from UR (please complete the following information and attach documentation from Dean's office):
Last semester attended Date of withdrawal
(ex: Fall 2005) (mm/dd/yyyy)
Reason for withdrawal
I am returning to UR after a leave of absence (please complete the following information and attach documentation of re-admission from the Dean's office):
Last semester attended Re-admission date (semester start date)
(ex: Fall 2005) (mm/dd/yyyy)
I am completing my educational program earlier than anticipated (please attach documentation of this change, such as Bannerweb or Registrar's report indicating early completion date):
Current completion date New completion date
(mm/dd/yyyy) (mm/dd/yyyy)
Reason for early completion
I am completing my educational program later than anticipated (please attach documentation of this change, such as Bannerweb or Registrar's report indicating delayed completion date):
Current completion date New completion date
(mm/dd/yyyy) (mm/dd/yyyy)
Reason for delayed completion
PLEASE RETURN THIS FORM BY EMAIL TO
Office of International Education
28 Westhampton Way, University of Richmond, VA 23173
FAX: +1 (804) 289-8904 TELEPHONE: +1 (804) 289-8836
DO NOT WRITE BELOW – FOR Office of International Education USE ONLY:
International Student Advisor Authorization
(signature)
Printed NameKrittika Onsanit Date
SEVIS reporting made by
(signature)
ACCESS database updates made by
(signature)
BANNER database updates made by
(signature)
Name Date
1