7
Start date of current J-1 Status: ________ through ________ mm/dd/yyyy
Program Sponsor (name/program number found on line 2 of DS-2019): ________
If in J visa status, have you applied for a waiver of 212 (e), the 2 year home residency requirement? ☐ Yes ☐ No
If you have applied for the waiver, has it been approved? ☐ Yes ☐ No (if yes, please include a copy of waiver)
Section 2: Financial Information
The minimum support for a single visitor is 1,500 per month, plus 625 per month for a spouse and 375 per month per child. If support is not from Kentucky State University, attach documentation in English with amounts in US Dollars.
Sources of FundsName of Source of FundingAmount (In US Dollars)
Kentucky State University
International Organization
Exchange Visitor Gov't
Other Organization
Personal Funds
Section 3: Dependent Family Information
If you require visa documents for your spouse or children, please complete this section. Important Notes: • DS-2019 documents can be issued only to dependent spouses and to unmarried, dependent children under 21 years of age. Married children and children over 21 years old cannot be issued a DS-2019 and cannot hold J-2 status.
Spouse's Information Full Name (as in passport): ________ Last/Family Name ________ First/Given Name ________ Middle Name (if any) ________
Date of Birth ________ mm/dd/yyyyGender: ☐ Male ☐ Female
Place of Birth ________ City ________ Province/State ________ Country ________
Citizen and Residence: ________ Country of Citizenship ________ Country of Permanent Residence ________
Email Address: ________
1st Child's Information\nFull Name (as in passport): ________ Last/Family Name ________ First/Given Name ________ Middle Name (if any) ________
Date of Birth ________ mm/dd/yyyyGender: ☐ Male ☐ Female
Place of Birth ________ City ________ Province/State ________ Country ________
Citizen and Residence: ________ Country of Citizenship ________ Country of Permanent Residence ________
mm/dd/yyyy
mm/dd/yyyy
Program Sponsor (name/program number found on line 2 of DS-2019
If in J visa status, have you applied for a waiver of 212 (e), the 2 year home residency requirement
If in J visa status, have you applied for a waiver of 212 (e), the 2 year home residency requirement
Yes
No (if yes, please include a copy of waiver
Sources of Funds
Name of Source of Funding_Kentucky State University
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Name of Source of Funding_International Organization
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Name of Source of Funding_Exchange Visitor Gov’t
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Name of Source of Funding_Other Organization
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Name of Source of Funding_Personal Funds
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Last/Family Name
First/Given Name
Middle Name (if any
mm/dd/yyyy
Gender
Gender
City
Province/State
Country
Country of Citizenship
Country of Permanent Residence
Email Address
Last/Family Name
First/Given Name
Middle Name (if any
mm/dd/yyyy
Gender
Gender
City
Province/State
Country
Country of Citizenship
Country of Permanent Residence