USAP J1 VISA APPLICATION

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Applicant Information:

                      Select Program Type Internship Training                    Length of Program:

Please enter the following information as it appears in the applicant's passport:

First Name:    Middle Name:    Last Name: 

Birth Date:         Gender:  M F ..       Country of Citizenship: 

Country of Legal Residence:          Country of Birth: 

City of Birth:      E-Mail:     Phone: 

Street Address:                   City:   

State/Province:             Postal Code: 

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Emergency Contact Information:

Full Name:    Relationship:    Phone Number: 

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Educational History:

Post-Secondary Institute - ( Outside of U.S.A. ): 

Field of Study: 

Is the applicant currently enrolled in University? No Yes  

If "No" , what is the month and year of graduation?  Click the Arrow January February March April May June July August September October November December    Click the Arrow 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

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Career History:

 

 

Job #1:

Company Name: 

Supervisor's Full Name:     Supervisor's Title: 

Job Start Date:                        Job End Date: 

Applicant's Job Title:   

Applicant's Job Description:

   

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Job #2:

Company Name: 

Supervisor's Full Name:     Supervisor's Title: 

Job Start Date:                        Job End Date: 

Applicant's Job Title:   

Applicant's Job Description:

   

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Job #3:

Company Name: 

Supervisor's Full Name:     Supervisor's Title: 

Job Start Date:                        Job End Date: 

Applicant's Job Title:   

Applicant's Job Description:

   

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Placement Information:

Please select a category for this placement:

Please make a selection Hospitality & Tourism Information Media & Communications Management, Business, Commerce & Finance Public Administration & Law The Sciences, Engineering, Architechture, Mathematics & Industrial

                Program Start Date:            Program End Date: 

Host Company Name: 

Host Company Street Address: 

City:     State:    Zip Code: 

Training Supervisor's Full Name: 

Training Supervisor's E-mail:       

Briefly describe what the applicant will be learning while training with the host company: