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J-1 Scholar Program Evaluation Form
To be completed by supervisor
J·1 scholars must make normal progress in their exchange program and complete all J·1 activities by the end date on their Forms DS-2019. This form is designed to assist you in discussing and evaluating a J·1 scholar's program activities.
Please meet with your ]-1scholar to discuss their progress before completing this form. Email a signed copy of this form, together with a one-page summary outlining the scholar's progress and accomplishment to OIA Director and RO at eric.yang@kysu.edu within 10 business days after receiving an email reminder.
NOTE: Departments should report any changes in a scholar’s J-1 program to OIA immediately for review and approval.
Evaluation period:___(mm/dd/yyyy) to___(mm/dd/yyyy)
Name of J-1 scholar: ___
Program activity: ___
Expected program end date:___(mm/dd/yyyy)
Overall rating: Excellent Good Poor
If poor, describe improvement plans:
Check as applicable to the J-1 scholar:
Yes No Possesses English language proficiency to conduct J-1activities.
Yes No Is making progress toward a timely, satisfactory completion of the J-1 program.
IN ALL THINGS EXCELLENCE
Kentucky State University is an equal educational and employment opportunity/affirmative action institution.
Office of International Affairs Cooperative Extension Building 109
Yes No Has been participating in cultural activities as required by the J-1 federal regulations
No Has been participating in cultural activities as required by the J-1 federal regulations
List of cultural activities:
Supervisor's name___
Title:_____ Department:_____
Email:_____Phone: __________ _____
Signature: _____ Date: _____