I request that Form DS-2019 be prepared for the person on the

International Student and Scholar Services (ISSS)
Miami University, Oxford, Ohio
Request for DS-2019 for International Scholar
I request that Form DS-2019 be prepared for the person on the second page, who is to be offered a temporary
appointment as a visiting scholar under the sponsorship of Miami University’s J-1 Exchange Visitor Program.
Send the completed form (following page) and all supporting documentation to Celia Ellison in Academic Personnel
(529-7268). After the appointment letter is complete, the information will go to ISSS and they will issue the DS-2019.
¾ If the Exchange Visitor is to be accompanied by dependents, please complete the “Request for DS-2019 for
Dependents.”
¾ If the Exchange Visitor is already in the U.S., please contact ISSS immediately ([email protected];
529-5628) and attach photocopies of current visa documentation (e.g. visa stamp, DS-2019). This information
is essential to determine eligibility for extension of stay and/or transfer to our Exchange Visitor Program.
Scholar Application Checklist
____ DS-2019 Request Form (following page)
____ Copy of Passport
____
Resume/CV
____ Documentation of funding (if not paid by Miami). Accepted documentation includes bank statement,
scholarship letter, salary statement, etc.
____ Employment Recommendation Form (if paid by Miami)
____ Documentation of previous J-1 status and/or current visa status (if applicable)
NOTE:
If the request is denied by the Department Chair, s/he should circle DENIED, sign the form, and return it to the faculty
supervisor for his/her records.
If the request is denied by the Dean, s/he should circle DENIED, sign the form, and return it to the Department Chair for his/her
records. The department chair should also provide the faculty supervisor with a copy of the form.
If the request is denied by the Provost, s/he should circle DENIED, sign the form, and return it to the Dean for his/her records.
The Dean should also provide the Department Chair and faculty supervisor with a copy of the form.
Please answer ALL questions on this form.
Name of Exchange Visitor__________________________________________________________________ Male
(Family name)
Date of
Birth__________________
(Month-Day-Year)
(First name)
(Middle name)
Place of
Birth_______________________________________
(City)
Female
(circle one)
Country of
Citizenship_____________________
(Country)
Country of Legal Permanent Residence _______________________________ Email address: __________________________
Current Position in home country ___________________ Employer/University in home country _________________________
Has this person held J-1/J-2 status in the past? Yes
No
(If yes, you must include a copy of most recent DS-2019)
Will any Miami faculty or students go to this person’s country or institution as part of a reciprocal exchange or partnership?
Yes
Dates of Appointment at Miami: Begin ________________________
No
End________________________
Location of Appointment: _________________________________________________________________Oxford, OH 45056
(Department)
(Building)
Might the appointment be extended beyond original end date? Yes No Expected maximum duration of program: _________
Subject Area of Specialization During Appointment:_____________________________________________________________
Brief description of the program or duties to be performed (researcher, professor, etc.) __________________________________
_______________________________________________________________________________________________________
Source and amount of the Exchange Visitor’s financial support in U.S. dollars (minimum $1200/month required):
From Miami University.............................................……….
Amount $_______________________
Funding from one or more U.S. Government Agencies..........
Amount $_______________________
Name Agency(ies):_____________________________________________
From other sources (specify)......................................………
Amount $_______________________
From personal funds...............................................………….
Amount $_______________________
Address (to mail DS-2019):
Street Address: ____________________________________________________________________________________
City: _______________________________________ Province: ____________________________________________
Country: ____________________________________ Postal Code: __________________________________________
Exchange Visitor’s Phone Number: ____________________________________________
Department account number for express mailing documents (e.g. INP 001): ___________________
Faculty Supervisor – Name, Phone # & email: _________________________________________________________________
Department Chair: APPROVED DENIED (circle one)
Signature:
_______________________________________________
Date
Department Chair’s Name (print):
_______________________________________________
Dean: APPROVED DENIED (circle one)
Signature:
__________________________________________________
Date
Provost: APPROVED DENIED (circle one)
Signature:
__________________________________________________
Date