J-1 Research Scholar Program Waiver Request Form
Submit your request for a waiver related to the J-1 Research Scholar Program. Please complete all required fields to ensure prompt review.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Department or Affiliation
*
Host Institution
*
J-1 Program Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
J-1 Program End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of Waiver Requested
*
Please Select
212(e) Two-Year Home Residency Requirement
No Objection Statement
Persecution
Exceptional Hardship
Other
Reason for Waiver Request
*
Supporting Documentation (PDF or DOCX)
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Waiver Statement: By submitting this form, I confirm that the information provided is accurate and that I am requesting a waiver for the J-1 Research Scholar Program as described above.
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