Visitor – Extending the Visit

Visiting Graduate Researcher or Visiting Scholar

Please answer the following questions to help us complete your DS-2019. All fields are required, so please enter "N/A" if one does not apply to your situation.
* indicates required field

General Information

Permanent Address Outside of US

U.S. Address

Program Information

Occupation and Education

If currently enrolled as a student, please specify the following:

Previous J Visa History

Financial Support Information
For the funding sources below, list financial support for the entire period covered by this form, and specify in US Dollars.
UCLA Department budget, grant, etc.
Exchange Visitor's Government
Include financial document in email with other required documents
Other organizations/institutions in the US or abroad
Include financial document in email with other required documents
Personal funds (email copy of bank statement in English)

Dependent Information

Copy of Dependent passport is required

For each dependent list the following:
  • Last, First name (as appears on passport)
  • Relationship: spouse, daughter, son
  • Date of birth (MM/DD/YYYY)
  • City of birth
  • Country of birth
  • Country of citizenship
  • Country of permanent residents
  • Email
  • Phone number

Medical Insurance

J-1 visitors at UCLA (other than those visitors who fall under the designated groups below) are required to enroll OR opt out of the Visiting Scholar Injury and Sickness Insurance Plan (VSISP) through Garnett-Powers & Associates. In order to opt out of the VSISP plan, J-1 visitors are required to show proof of health insurance with the following minimum coverage:
  • All $100,000 per accident or illness.
  • An annual deductible not exceeding $250.
  • $50,000 minimum coverage for expenses associated with the medical evacuation to the visitor’s home country. (international only)
  • $25,000 minimum coverage for expenses associated with repatriation of remains to exchange visitor's home country. (international only)
  • Pre-existing conditions must be covered after a 12-month waiting period.
  • Coverage may include a provision for maximum 25% coinsurance or co-payment paid by the visitor. Coinsurance must allow for customary & reasonable charges in US dollars, not equivalent cost for services in home country.
  • Coverage cannot exclude benefits for perils inherent to the activities of the program in which the visitor participates.
  • Policy must be underwritten by an insurance corporation meeting the US Department of State rating requirements or backed by the full faith and credit of the visitor's home country government, designated sponsor, or exchange visitor's employee group plan.
Information regarding eligibility, requirements, enrollment and the waiver approval process can be found on the Garnett-Powers site at VSISP enrollment confirmation will be sent to the J-1 visitor by email. Visitor must print and bring for check-in. Those approved for the waiver, must bring their waiver confirmation and proof of medical insurance used to waive.


Required Documents
If you have difficulty uploading documents, please email them to .

Acceptable file types: doc,docx,pdf,txt,gif,jpg,jpeg,png.
Maximum file size: 1mb.
(see DS-2019 Instructions for requirements)

(see Exchange Visitor Regulation Guidelines)

(See VGR website for more details)

UCLA Civil and Environmental Engineering