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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.

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Office of International Affairs

Cooperative Extension Building 109

Yes

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: _____