J-1 Teacher Exchange Application
Preferred Program Duration
6 months
12 months
24 months
36 months (maximum)
No. of years teaching experience
Title
Mr.
Ms.
Dr.
Family Name
First Name
Other name(s)
Gender
Male
Female
Marital Status
Single
Married
Birth Date
Birth Place
Country of Birth
Citizenship
Country of Permanent Legal Residence
Are you bringing your dependent(s)?
No
Yes
If yes: (please select)
Dependent(s) will arrive with me
Dependent(s) will arrive later
New option_3
Expected arrival date of dependent(s)
Permanent Address
Current Address
Do you have a previous J-1 Visa?
No
Yes
If yes: Date of entry to US
Date of Exit from US
Previous US visa
Previous US visa refusal (indicate date)
TOEFL Score or Equivalent
Date of test
Are you a native English speaker
No
Yes
Speaking (English)
Poor
Fair
Good
Excellent
Readiing (English)
Poor
Fair
Good
Excellent
Writing (English)
Poor
Fair
Good
Excellent
Educational Background
Bachelor's Degree
Master's Degree
Doctorate
School Name
Address
Country
Begin Date
End Date
Major
Degrees or Certificates
Current Employer
Address
Country
Begin Date
Job Title
Previous Employer
Address
Country
Begin Date
End Date
Job Title
Previous Employer
Address
Country
Begin Date
End Date
Job Title
Your Email Address
Telephone Number
Mobile Number