Forms & Links Visitor Overview Visitor - Extending the Visit 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 Select a contact:* Select CEE SAO (for VGRs) Payroll Analyst (for Visiting Scholars/Postdoctoral Scholars) Visitor Type:* Visiting Graduate Researcher Visiting Scholar Postdoctoral Scholar Visiting Graduate Researchers are students currently enrolled in a graduate program. If you are a registered student, you must apply as a Visiting Graduate Researcher. GENERAL INFORMATION Last or family name (as it appears on passport):* First or given name (as it appears on passport):* Gender:* Female Male Date of birth:* Are you married?* Yes No City of birth:* Country of birth:* Country of citizenship:* Country of permanent residence:* Email:* Primary phone number:* ADDRESSES Permanent Address Outside of US Street address:* Room number: City:* State/Province:* Postal code:* Country:* Mailing Address (may be within or outside of US) Street address* Room number: City:* State/Province:* Postal code:* Country:* PROGRAM INFORMATION Appointment start date:* Appointment end date:* Using no more than 15 words, describe the type of research you will be conducting:* OCCUPATION AND EDUCATION What is your current or last activity in your home country (country of citizenship/permanent residence)?* Student Researcher Professor Other (please specify) If answered "Other," please specify: If currently enrolled as a student, please specify the following: Level:* Name of institution:* Expected date of degree:* If employed, please specify the following: Job title: Name of employer: Highest academic degree earned (BS, MS, PhD, etc.):* Date awarded (MMYYYY):* PREVIOUS J VISA HISTORY During the last two years, have you been issued any J-1 and/or J-2 status in the US?* Yes No If you answer yes, you must attach a copy of your previous J-1 and/or J-2 visas below (see Required Documents section). Are you currently in the US?* Yes No If you are currently in the US, under which visa type? (Enter "N/A" if you are not currently in the US):* 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. Monthly amount: Total amount: Please include appropriate financial document when emailing your other required documents. Name of agency: Monthly amount: Total amount: Other organizations/institutions in the US or abroad Please include appropriate financial document when emailing your other required documents. Name(s): Monthly amount: Total amount: Personal funds Please email a copy of your bank statements in English. Monthly amount: Total amount: Check here to confirm that at least 51% of financial support comes from non-personal or family sources. Note: This only applies to Visiting Graduate Researchers, but if you are a Visiting Scholar, you will need to check this box to submit this form.* DEPENDENT INFORMATION Copy of Dependent's passport is required For each dependent, list the following: Last name, first name (as it appears on their passport) Relationship Date of birth (MM/DD/YYYY) City of birth Country of birth Country of citizenship Country of permanent residents Email Phone number Enter information below:* MEDICAL INSURANCE Indicate whether you will enroll or waive VSISP medical insurance:* Plan to enroll Plan to waive 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 https://clients.garnett-powers.com/vs/ucla/. 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. FEES Have you read and understood the VGR fees posted at the link below? (Does not apply to Visiting Scholars) Yes No N/A (Visiting Scholar) https://grad.ucla.edu/academics/research/visiting-graduate-researchers Do you understand that some of these fees are non-refundable? Yes No N/A (Visiting Scholar) jPATH ORIENTATION REQUIREMENT As an international J-1 scholar or non-degree student you are required to complete a J-1 orientation per U.S. Department of State regulations. UCLA jPATH Orientation is composed of several components that must be completed by the end of week 2 of your UCLA program. You will receive information about jPATH when issued a DS-2019 form, but you should be aware that failure to complete jPATH may also lead to the cancellation of your J-1 visa status since orientation is a U.S. Department of State requirement. More information about the program can be found here. Please indicate that you understand this requirement by checking this box.* REQUIRED DOCUMENTS If you have difficulty uploading documents, please email them to email@example.com. Resume/CV: Acceptable file types: .Maximum file size: 1mb. Copy of picture page of passport: Copy of picture page of passports of dependents (if applicable): Proof of financial support: (see DS-2019 Instructions for requirements) Health insurance information: (see Exchange Visitor Regulation Guidelines) English Language Proficiency form: (Form is available here) Proof of registration (required for VGRs only): (See VGR website for more details) If issued a J-1 in the past 2 years, must also submit copies of previous DS-2019s: Additional comments (optional): If you encounter any errors submitting this form or completing the CAPTCHA, please complete this form and email it to firstname.lastname@example.org along with the required documents listed above.