Section 4 to be completed by KSU Hosting Department. Be sure to type or print clearly
Section 4: Department Information and Approval
Dates of Intended Sponsorship: ________________ through ________________
Category: ☐ Professor ☐ Research Scholar ☐ Short-Term Scholar (up to 6 months)
Indicate field in which the visitor will research/teach at KSU
KSU Department: ________________
J-1 Host's Name: ________________
Email: ________________ Phone Number: ________________
Type of Supervisor: ☐Direct (close supervision) ☐Indirect (will work independently)
Is the proposed visitor a relative or family member of the hosting faculty member? No ☐ Yes ☐
Required Documentation to be Submitted with this Form
☐ Original Invitation Letter to Visitor
☐ Detailed Description of Activity, which describes what the visitor will be doing while at KSU
☐ All required signatures
☐ Proof of English Language Proficiency
By signing below, we attest that we will comply with the following responsibilities in hosting a J-1 visitor:
The department agrees to host the scholar included on this form as a J-1 Exchange Visitor and have re3ad and understand the host responsibilities outlined on page 3.
The department will have the J-1 Exchange Visitor (and any accompanying dependents) make an appointment to check in with OGSIA by the first day of his/her appointment so that OGSIA can fulfill SEVIS reporting requirements.
If the exchange visitor decides to not come to KSU or will be delayed in arriving, the department will inform OGSIA as soon as possible.
The department understands that all J-1 Exchange Visitors and their J-2 dependents are required by Kentucky State University and the U.S. Department of State to be covered by health insurance.
Required Signatures:
Hosting Faculty Member: ________________ Date: ________________
Department Chair: ________________ Date: ________________
Dean: ________________ Date: ________________
HR Officer: ________________ Date: ________________