J-1 Visa 212(e) Waiver Application Form

J-1 Visa 212(e) Waiver Application Form
Complete this form to request a J-1 visa 212(e) waiver. Please ensure all information is accurate and all required documents are uploaded.
Full Name
First NameLast Name
Date of Birth
MonthDayYear
Date
Nationality / Country of Citizenship
Current U.S. Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
J-1 Program Category
Current Waiver Request Basis / Reason
Upload Supporting Documents
Cancelof
I hereby declare that the information provided is accurate and complete.
Should be Empty: