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Syria
Tanzania
Togo
Tromelin Island
Tunisia
Uganda
United Arab Emirates
West Bank
Western Sahara
Yeman (Sanaa)
Yemen
Yemen (Aden)
Zambia
Zimbabwe
Guam (U.S. Territory)
Puerto Rico (U.S. Territory)
English-speaking, other
Neutral Zone
Stateless
Unknown
Phone :
Email Address:
Current/Most Recent Academic or Professional Status
Current/Most Recent:
High School
College/University
Graduate School
Employed
Academic Experience
Current/Most Recent-Degree:
High School Diploma
Associate's Degree
Bachelor's Degree
Master's Degree
PhD
JD
Diploma
Degree received on/will be received on:
Field of Study:
Agriculture, Agriculture Operations, and Related Sciences
Architecture and Related Services
Biological and Biomedical Sciences
Business, Management, Marketing, and Related Support Services
Communication, Journalism, and Related Programs
Communications Technologies/Technicians and Support Services
Computer and Information Sciences and Support Services
Construction Trades
Education
Engineering Technologies/Technicians
Engineering
Family and Consumer Sciences/Human Sciences
Health Professions and Related Clinical Sciences
Legal Professions and Studies
Library Science
Mathematics and Statistics
Mechanic and Repair Technologies/Technicians
Military Science, Leadership and Operational Art
Natural Resources and Conservation
Parks, Recreation, Leisure and Fitness Studies
Personal and Culinary Services
Physical Sciences
Precision Production
Public Administration and Social Service Professions
Science Technologies/Technicians
Social Sciences
Transportation and Materials Moving
Visual and Performing Arts
Other
Other:
Field of Study:
Agriculture, Agriculture Operations, and Related Sciences
Architecture and Related Services
Biological and Biomedical Sciences
Business, Management, Marketing, and Related Support Services
Communication, Journalism, and Related Programs
Communications Technologies/Technicians and Support Services
Computer and Information Sciences and Support Services
Construction Trades
Education
Engineering Technologies/Technicians
Engineering
Family and Consumer Sciences/Human Sciences
Health Professions and Related Clinical Sciences
Legal Professions and Studies
Library Science
Mathematics and Statistics
Mechanic and Repair Technologies/Technicians
Military Science, Leadership and Operational Art
Natural Resources and Conservation
Parks, Recreation, Leisure and Fitness Studies
Personal and Culinary Services
Physical Sciences
Precision Production
Public Administration and Social Service Professions
Science Technologies/Technicians
Social Sciences
Transportation and Materials Moving
Visual and Performing Arts
Other
Other:
Work Experience
Total Work Experience (if not currently a student):
None
Up to 3 Months
4-6 Months
7-9 Months
10-12 Months
13-18 Months
19-24 Months
25-36 Months
More than 3 years
Current Occupation:
Agriculture, Agriculture Operations, and Related Sciences
Architecture and Related Services
Biological and Biomedical Sciences
Business, Management, Marketing, and Related Support Services
Communication, Journalism, and Related Programs
Communications Technologies/Technicians and Support Services
Computer and Information Sciences and Support Services
Construction Trades
Education
Engineering Technologies/Technicians
Engineering
Family and Consumer Sciences/Human Sciences
Health Professions and Related Clinical Sciences
Legal Professions and Studies
Library Science
Mathematics and Statistics
Mechanic and Repair Technologies/Technicians
Military Science, Leadership and Operational Art
Natural Resources and Conservation
Parks, Recreation, Leisure and Fitness Studies
Personal and Culinary Services
Physical Sciences
Precision Production
Public Administration and Social Service Professions
Science Technologies/Technicians
Social Sciences
Transportation and Materials Moving
Visual and Performing Arts
Other
Other:
Practical Training
Internship Start Date:
Internship End Date:
Internship/Practical Training Field:
Agriculture, Agriculture Operations, and Related Sciences
Architecture and Related Services
Biological and Biomedical Sciences
Business, Management, Marketing, and Related Support Services
Communication, Journalism, and Related Programs
Communications Technologies/Technicians and Support Services
Computer and Information Sciences and Support Services
Construction Trades
Education
Engineering Technologies/Technicians
Engineering
Family and Consumer Sciences/Human Sciences
Health Professions and Related Clinical Sciences
Legal Professions and Studies
Library Science
Mathematics and Statistics
Mechanic and Repair Technologies/Technicians
Military Science, Leadership and Operational Art
Natural Resources and Conservation
Parks, Recreation, Leisure and Fitness Studies
Personal and Culinary Services
Physical Sciences
Precision Production
Public Administration and Social Service Professions
Science Technologies/Technicians
Social Sciences
Transportation and Materials Moving
Visual and Performing Arts
U.S. Host Organization
Please list the contact information for your host company below.
Company Name:
Street:
Street 2:
City:
State/Province:
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland And Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Berlin
Brandenburg
Baden-Wuerttemberg
Bavaria
Bremen
Hesse
Hamburg
Mecklenburg-Western Pomerania
Lower Saxony
North Rhine-Westphalia
Rhineland-Palatinate
Schleswig-Holstein
Saarland
Saxony
Saxony-Anhalt
Thuringia
Pennsylvania
West Virginia
Maryland
Virginia
District Of Columbia
Delaware
New York
New Jersey
Nebraska
Minnesota
Michigan
Missouri
Kansas
Indiana
Illinois
Iowa
Ohio
Wisconsin
Vermont
New Hampshire
Connecticut
Massachusetts
Maine
Rhode Island
U.S. Minor Outlying Islands
American Embassy
Northern Mariana Islands
Puerto Rico
Palau
American Samoa
Virgin Islands Of The U.S.
Guam
Federated States Of Micronesia
Marshall Islands
Texas
South Carolina
Alabama
Arkansas
Tennessee
Oklahoma
Florida
New Mexico
Georgia
North Carolina
Kentucky
Mississippi
Louisiana
Washington
Alaska
Oregon
Nevada
Idaho
Hawaii
California
Arizona
South Dakota
North Dakota
Utah
Montana
Colorado
Wyoming
Postal Code:
Country:
Canada
Germany
United States
Antarctica
Ashmore & Cartier Islands
Australia
Baker Island (U.S. Territory)
Bangladesh
Bhutan
British Indian Ocean Territory
Burma
Cambodia
Canton And Enderbury
Cape Verde
Central & Southern Line Islands
China
Christmas Island
Cocos (Keeling) Islands
Comoros
Cook Islands
Coral Sea Islands
Democratic Republic Of Viet-Nam
East Timor
Faroe Islands
Fiji
French Polynesia
French Southern And Antarctic Lands
Gilbert & Ellice Islands
Gilbert Islands
Heard Island & Mcdonald Slands
Hong Kong
Howland Island (U.S. Territory)
India
Indonesia
Japan
Jarvis Island (U.S. Territory)
Johnston Atoll (U.S. Territory)
Kingman Reef (U.S. Territory)
Kiribati
Laos
Macau
Malaysia
Maldives
Marshall Islands
Micronesia, Federated States Of
Midway Islands (U.S. Territory)
Mongolia
Nauru
Nepal
New Caledonia
New Zealand
Niue
Norfolk Island
North Korea
Northern Mariana Islands (U.S. Territory)
Pakistan
Palau
Palmyra Atoll (U.S. Territory)
Papua New Guinea
Paracel Islands
Philippines
Pitcairn Islands
Portuguese Timor
Republic Of Viet-nam
Reunion
Samoa
Sikkim
Singapore
Solomon Islands
South Korea
Southern Ryukyu Islands
Spratly Islands
Sri Lanka
Taiwan
Thailand
Tokelau
Tonga
Trust Territory Of The Pacific Islands
Tuvalu
United States Misc. Pacific Islands
Vanuatu
Vietnam
Wake Atoll (U.S. Territory)
Wallis & Futuna
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia & Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Czechoslovakia
Denmark
Estonia
Finland
France
Georgia
Gibraltar
Greece
Greenland
Guernsey
Hungary
Iceland
Ireland
Isle Of Man
Israel-Syria Demilitarized Zone
Italy
Jan Mayen
Jersey
Kazakhstan
Kosovo
Kyrgyzstan
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Montenegro (Prior to 2001)
Netherlands
Norway
Poland
Portugal
Romania
Russia
Saint Helena
Saint Martin
Saint Pierre & Miquelon
San Marino
Serbia
Serbia (Prior to 2001)
Serbia (Prior to 2009)
Serbia & Montenegro
Slovakia
Slovenia
South Georgia & The South Sandwich Islands
Spain
Svalbard
Svalbard And Jan Mayen
Sweden
Switzerland
Tajikistan
Turkey
Turkmenistan
Ukraine
Union Of Soviet Socialist Republics
United Kingdom
Uzbekistan
Vatican City
Yugoslavia
American Samoa
Anguilla
Antigua & Barbuda
Argentina
Aruba
Bahamas, The
Barbados
Belize
Bermuda
Bolivia
Brazil
British Virgin Islands
Cayman Islands
Chile
Clipperton Island
Colombia
Costa Rica
Cuba
Dominica
Dominican Republic
Ecuador
El Salvador
Falkland Islands (Islas Malvinas)
French Guiana
Grenada
Guadeloupe
Guatemala
Guyana
Haiti
Honduras
Jamaica
Martinique
Mexico
Montserrat
Navassa Island (U.S. Territory)
Netherlands Antilles
Nicaragua
Panama
Paraguay
Peru
Saint Barthemely
Saint Kitts & Nevis
Saint Lucia
Saint Vincent & The Grenadines
Suriname
Swan Islands
Trinidad & Tobago
Turks & Caicos Islands
Uruguay
Venezuela
Virgin Islands (U.S. Territory)
Afghanistan
Algeria
Angola
Bahrain
Bassas Da India
Benin
Botswana
Bouvet Island
Brunei
Burkina Faso
Burundi
Cameroon
Canal Zone
Central African Republic
Chad
Congo
Congo, Democratic Republic Of The
Cote D Ivoire
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Europa Island
French Territory Of The Afars And Issas
Gabon
Gambia, The
Gaza Strip
Ghana
Glorioso Islands
Guinea
Guinea-Bissau
Iran
Iraq
Iraq-Saudi Arabia Neutral Zone
Israel
Israel-Jordan Demilitarized Zone
Jordan
Juan De Nova Island
Kenya
Kuwait
Lebanon
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Mayotte
Morocco
Mozambique
Namibia
Niger
Nigeria
Oman
Qatar
Rwanda
Sao Tome & Principe
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Southern Rhodesia
Spanish North Africa
Spanish Sahara
Sudan
Swaziland
Syria
Tanzania
Togo
Tromelin Island
Tunisia
Uganda
United Arab Emirates
West Bank
Western Sahara
Yeman (Sanaa)
Yemen
Yemen (Aden)
Zambia
Zimbabwe
Guam (U.S. Territory)
Puerto Rico (U.S. Territory)
English-speaking, other
Neutral Zone
Stateless
Unknown
Contact First Name:
Contact Last Name:
Contact Telephone:
Contact Email:
ATTORNEY (if applicable)
If you are aware of legal representation supporting you or your host company in this J-1 Visa process.
First Name:
Last Name:
Firm Name:
Email:
Insurance
Health and Accident Insurance
Cultural Vistas, Inc., in accordance with the Bureau of Educational and Cultural Affairs' (ECA)
regulations for
exchange visitors (22 CFR Part 62), requires that all participants and accompanying dependents have
health and accident
insurance in effect for the duration of their stay in the United States. As
a Train USA
participant, you are
required
to purchase health and accident insurance through Cultural Vistas, which meets the requirements of
ECA regulations.
Please note that government regulations for the J-1 Intern and Trainee programs permit you to arrive
in the U.S. up
to 30 days before the beginning of your internship and to stay up to 30 days after your internship
ends. Cultural Vistas
recommends that you maintain health insurance coverage for your entire stay in the U.S. If you wish,
you may purchase
additional health insurance from Cultural Vistas to cover the period before and/or after your
internship.
Will your spouse or child come with you to the U.S.?:
Yes
No
You will be prompted to indicate your insurance coverage for you and your dependents when you submit
your application.
Please begin reviewing the insurance options that we offer for J-2 coverage.
(For further details click here)
You have a choice of
two coverage
options
which you can choose now or when you submit your application. Payment in full is due prior to DS-2019
issuance.*
Please review the
two plans
carefully before choosing and consult with your host company if they are paying the fees:
Choose Insurance:
Would you like to purchase additional insurance?
I would like to purchase an extra month of insurance to cover
the period before my internship start date.
I would like to purchase an extra month of insurance to cover
the period after my internship end date.
Both
Neither (No additional charge)
Learned About Cultural Vistas
How did you hear about the program?:
Embassy, Consulate, or Government Agency
Conference
Info Session
Webinar
Other event
Job Boards
Magazine, Newspaper, or Print Publication
Online Search
Alumni of Program
Attorney
Colleague
Current participant
Employer
Family or friend
Member of Congress
Nominator
Organization
Other
Professional Associations
Facebook
Twitter
LinkedIn
Other
CEWIL/ UBC/ UoT PEY
UUKi/BUTEX
Career Services
Email/Listserv
Fair or Info Session
Study Abroad or International Programs Office
Job Board
Professor/Advisor
Scholarship or Fellowships office
Other
Website
Referral Code (if applicable):
Express Service
If you are applying for a J-1 visa on a tight deadline, Cultural Vistas Express Service can help.
With the Express Service, we will issue a sponsorship decision within five business days of receiving all participant
and host company application materials and payment of program fees. An additional fee of
US$1350 applies.
If you'd like to request Express Service, please check here: