TEXAS CHRISTIAN UNIVERSITY

 

                                                   REQUEST FOR FORM DS-2019

           (CERTIFICATE OF ELIGIBILITY FOR EXCHANGE VISITOR [J-1] STATUS)

 

Please complete this form, attach a copy of the recommendation for appointment (if it has not already been processed), and forward them to the Provost/VC Academic Affairs, TCU Box 297040.

 

Visitor's Name:

                                    (last)                    (first)                    (middle)

Male Female

 

Visitor's Current mailing address: 

 

 

Date of birth: January February March April May June July August September October November December 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Place of Birth:

                                month               day      year                                                (city & country)

 

 

Citizen of:  Legal Permanent Resident:

                                (country)                                                                                                 (country)

Visitor's position in home country is:

 

 

Dates for TCU appointment/visit will be from to

 

The specific field of study, research, or professional activity at TCU will be:  

 

 

Financial Support provided by TCU for this Exchange Visitor is $ .

Financial support provided from other sources for this Exchange Visitor is $.

 

Source(s):

 

 

Does Exchange Visitor intend to bring any family members with him/her? yes     no

 

If so, whom? 

        Name                                  Relationship            Place of Birth            Date of Birth                Nationality

        Name                                  Relationship            Place of Birth            Date of Birth                Nationality

        Name                                  Relationship            Place of Birth            Date of Birth                Nationality

 

Remarks:

 

Faculty Member or Department Chair:

 

TCU Department:

 

 

Provost 1/03

DS-2019req.doc