Services for International Students and Scholars(T) 530-752-0864
University of California, Davis(F) 530-752-5822
J-1 Scholar/J-2 DependentDS-2019 Travel Signature Request Form
Instructions for J-1 International Scholars or J-2 Dependents Traveling Outside the United States
Time needed for processing at SISS: One Business Day
In order to travel outside the United States and return to UCD, your DS-2019 must be validated and signed for travel.The signature is valid for six months.Please do the following:
1. Request appropriate leave from your supervisor/ host professor (unless this is for a J-2 only).
2. Complete, sign and date this request form.
3. Have the J-1 scholar department contact* or host professor sign and date this request form (even if it is for a J-2).
4. Submit this form to SISS with your most recent original DS-2019 for yourself and/orJ-2 dependents.
5. If you are a J-1 scholar who will be outside the US for more than 30 days, please request a letter from your host professor, permitting and explaining your need for an extended absence (whether business, home visit, etc.) for every trip abroad.
Please note:
- If your DS-2019 was issued by the Humphrey Fellows Program, Fulbright, or any program sponsor who is not UC Davis, you must obtain a travel signature from your program sponsor and not UCD.
For J-1 Scholar or J-2 Dependent to Complete
Name:(Family) / (Given) / (Middle)
Current Local Address:
(Street) / (Apt. #) / (City) / (State) / (Zip Code)Home Phone: / E-mail:
Department Phone: / Passport Expiration Date:
I must apply for new J-1/J-2 visa during this trip: / Yes / No
Visa Expiration Date: / Have you applied for or been granted a waiver of the 212e (2 Year Home Residence) requirement? / Yes / No
Travel Destination: / Departure Date: / Return Date:
I understand that I will need to have a valid J-1or J-2 visa in my passport to re-enter the USA.
I certify that the above information is true and correct. I verify that my intention is to return to the United States to continue my Exchange Visitor program on or about the date listed above.
Signature of Exchange Visitor:______Date:______
FOR J-1 Scholar’sDepartment Use ONLY – to be completed even if only J-2 dependent(s) are traveling.
The J-1 scholar (or J-2 spouse) listed above is in good standing and has been conducting the research and/or activity for which his or her DS-2019 was issued. The department will notify SISS if there are any changes.
Signature of Department Contact*or Host Professor: ______
Please Print Name: / Phone: / Date: / /*A “Department Contact” is generally the person who originally requested the DS-2019 document for the scholar to first enter the U.S.and/or the person who assists with payroll and personnel issues.
FOR SISS USE Only:DS-2019 Signed for Travel (Initials): / Date:Rev 11/12