Prospective Intern Must Attach the Following Documents

J-1 Intern Program InformationForm

UC International Services

47 W. Corry St., 3134 Edwards Center ONE

Cincinnati, OH 45221-0640

Tel: (513)556-4278; Fax: (513)556-2990;

Prospective Intern must attach the following documents:

Current résumé

Official transcript from current postsecondary academic institution

Copies of transcripts from previous postsecondary academic institutions and copies of diplomas for all degrees earned (if applicable)

Copy of passport ID page and any renewal pages (and passport ID pages for dependents, if applicable)

If in the United States in the past 24 months in Exchange Visitor status, copies of supporting documents (DS-2019, Visa stamp, I-797, etc.)

Signed Training Internship Placement Plan (Form DS-7002)

J-1 Intern Program Academic Advisor Recommendation Form, completed by academic advisor or dean

Evidence of financial support for yourself and any accompanying dependents

Proof of medical insurance meeting the requirements. If you already have insurance please attach that documentation. If not, proof of insurance will be required upon check-in with UC International Services.

Letter on official letterhead stationary from academic advisor, dean or registrar, in English, certifying current enrollment in accredited institution, degree level, and academic standing

Verifiable English language skills sufficient to function on a day-to-day basis in their training environment. English language proficiency must be verified by a recognized English language test. Acceptable scores include a minimum of 66 on the Test of English as a Foreign Language (TOEFL); 6.5 overall band score on the International English Language Test Score (IELTS), 46 on PEARSON, a Grade C or higher on the Cambridge English Language Assessment test, or a score of 780 or above on the Test of English for International Communication (TOEIC). In place of an acceptable score on an English language test, prospective interns can take the Oral English Proficiency Test for Visiting Scholars online at There is a $50 fee to take the test. Documents not in English must be accompanied by a certified translation.

Biographical Information

Please legibly print or type your responses. Respond to every item.

Family Name:______

Middle Name: ______

Gender: ____ Male ____ Female

Email:______

City of Birth:______

Given Name:______

Other Names Used:______

Marital Status: ____Married ____Single

Date of Birth (mm/dd/yyyy): ______

Country of Birth: ______

Country of citizenship:______

Country of Legal Permanent Residence:______

Current Country of Residence:______

Credentials

CURRENT LEVEL OF ENROLLMENT: ___Bachelor’s ___Master’s ___Doctoral ___Other, please specify______

CURRENT FIELD OF STUDY: ______Name of Institution: ______

LOCATION/ADDRESS: ______

HAVE YOU EVER STUDIED IN THE UNITED STATES? ____NO ____YES

HAVE YOU EVER PARTICIPATED IN AN INTERNSHIP IN THE UNITED STATES? ____NO ____YES

(If you have studied or participated in an internship in the United States, please provide a brief description. For internship, please include duties/responsibilities, company or organization information, dates, and immigration status)

______

______

______

______

Addresses

HOME COUNTRY ADDRESS OR COUNTRY OF LEGAL PERMANENT RESIDENCE:

Street Address: ______

City: ______State/Province: ______

Country: ______Postal Code: ______

ADDRESS TO WHICH DOCUMENTS ARE TO BE SENT (if different than above):

Street Address: ______

City: ______State/Province: ______

Country: ______Postal Code: ______

Proof of English Proficiency

All Interns must provide proof of English language skills sufficient to function on a day-to-day basis in their training environment. English language proficiency must be verified by a recognized English language test. Acceptable scores include a minimum of 66 on the Test of English as a Foreign Language (TOEFL); 6.5 overall band score on the International English Language Test Score (IELTS), 46 or higher on PEARSON, a Grade C or higher on the Cambridge English Language Assessment test, or a score of 780 or higher on the Test of English Form International Communication (TOEIC). In cases where an Intern does not have an English proficiency test score from one of the recognized tests, Interns can make arrangements through UC International Services to have an online test taken through the University of Cincinnati’s English as a Second Language Center at

Financial Support

Provide information about how you will support yourself financially while in the United States. Attach documents that certify financial support. All financial support documents should be recently dated and written in English or officially translated. The amounts must be stated in U.S. dollars. (The minimum requirement for support must total $1,500 per month, based on a minimal estimate of monthly housing, utilities, transportation, food, insurance and personal expenses as well as minimum wage data in Ohio/Kentucky. Please see dependent section, if applicable).

Passport and Visa History

Passport Number: ______Expiration Date (mm/dd/yyyy): ______

Have you been, or are you currently an exchange visitor? ___ YES ___ NO

If yes, were you subject to the 2-year home residence requirement? ___ YES ___ NO

If yes, have you satisfied this requirement? ___ YES ___NO

If no, have you obtained a waiver of this requirement? ___ YES ___NO

(if yes, please provide copy of the waiver)

Intent to Return to Home Institution

All Interns are expected to return to the foreign postsecondary academic institution where they areenrolled or were recently enrolled immediately following the completion of the Internship.

I hereby attest that I intend to return to the foreign postsecondary academic institution where I will continue to pursue my degree program(or simply return home if already graduated) immediately following the completion of the Internship at the University of Cincinnati.I understand that I will have 30 days after the completion date to remain in the United States legally to travel domestically and prepare to leave the United States. I understand that if I leave the Intern program early, I will forfeit the 30-day grace period and will be expected to leave the United States immediately.

SIGNATURE: ______DATE______

Medical Health Insurance Requirement

All Interns and any accompanying dependents must provide evidence that they are covered by adequate medical insurance that meets the requirements set by the U.S. Department of State. Minimum health insurance coverage must provide:

• Medical benefits of at least $100,000 per accident or illness;
• In case of death, repatriation of remains in the amount of $25,000;
• In case of serious illness or injury, payment of expenses associated with the medical evacuation of the exchange visitor to his or her home country in the amount of $50,000;
• A deductible not to exceed $500 per accident or illness; and
• Co-insurance (co-pay) not to exceed 25%

Interns can find more information about the health insurance requirement and links to policies that meet the requirements at

I attest that I have read and understood the information above regarding health insurance for myself and any dependents accompanying me to the United States. (Please check all that apply below)

___ My educational institution, government, or other educational program will provide insurance for me and any accompanying dependents. (List information about insurer below and attach evidence of coverage to this form)

Name of Insurance Company: ______

Street Address: ______

City/Province/Country/Postal Code: ______

___ I will be paid by the University of Cincinnati for one yearand will therefore qualify for UC employee medical insurance.

___ I plan to purchase a Health Insurance Plan provided by UC International Services upon arrival for myself and any accompanying dependents.

INTERN’S SIGNATURE: ______DATE ______

Dependent Information

ELIGIBILITY FOR J-2 DEPENDENT STATUS

If your spouse and/or children will accompany you to the United States, they may apply for J-2 visas and reside with you in the United States as your dependents. Only a spouse or a child (under the age 21) may enter as your dependent. Other family members [such as a domestic partner or fiancé(e)] must apply for a Visitor’s visa (B-1/B-2) to enter the United States.

OFFICIAL EVIDENCE OF ADDITIONAL FINANCIAL SUPPORT in English is required for each dependent. The minimum amount is $500/month for a spouse and $250/month for each child.

MEDICAL INSURANCE meeting the U.S. department of State requirements must be maintained for all J-2 dependents. If you qualify for the UC employee medical insurance, your dependents can be added to the same plan. If your academic institution, government, or other educational sponsor will provide medical insurance, you must provide documentation of coverage for yourself and all dependents. A plan may be purchased upon arrival. Failure to maintain adequate medical coverage for J-2 dependents is grounds for termination of the Intern’s program.

Please provide all of the following information and copies of passport ID pages for each prospective dependent.