J-1 Exchange Visitor Info Form

This form is used to collect the information necessary to support J-1 Exchange Visitors as they join the Amherst community. This form should only be filled out by:

individuals hired as Language Assistants by the French, Spanish, German, and Russian Departments
students attending Amherst College as part of an exchange program

Your DS-2019 cannot be issued until all mandatory fields in this form are completed and you have submitted the form. Be certain that the information provided here is identical to the information contained in the passport that you will be using to travel to the United States.

Amherst College Status:

Please select the category that applies to you.

Personal Information

Family Name/Surname/Last Name:

First Name/Given Name:

Middle Name(s):

Full Name (as it appears on your passport):

First/Middle/Last

Sex (as indicated on your passport):

Date of Birth:

City of Birth:

Country of Birth:

Country of Citizenship:

(Identify all countries through which you hold citizenship; if you hold multiple citizenships, separate the countries by commas. For example: United Kingdom, Republic of Ghana)

Country of Passport:

(If you are a citizen of more than one country, specify which country's passport you will use for travel to the United States as a student)

Country of Permanent Residence:

Permanent Residential Home Country Address

Street Address (line one):

Street Address (line two):

Street Address (line three) :

City:

Province/Territory:

Postal Code: :

Country:

Phone Number:

Email Address:

Please enter your address in the manner typically used in your home country.

Information of Parents, or Close Relative--Preferred Contact

Family Name/Surname/Last Name:

First Name/Given Name:

Relationship (Father, Mother, Sibling, Aunt, Uncle, Friend):

Street Address (line one):

Street Address (line two):

City:

State::

Postal Code: :

Country:

Phone Number:

E-Mail Address 1:

Information of Parents, or Close Relative--Secondary Contact

Family Name/Surname/Last Name:

First Name/Given Name:

Relationship (Father, Mother, Sibling, Aunt, Uncle, Friend):

Street Address (line one):

Street Address (line two):

City:

State::

Postal Code: :

Country:

Phone Number:

E-Mail Address 1:

Passport Image Upload:

Please upload a photo/copy of your passport biographical page. (The 'bio page' in your passport is the primary page of your passport. It typically provides key information such as your full name, date of birth, and citizenship information.)
Files must be less than 750 MB.
Allowed types: jpg jpeg gif prc png txt doc docx xls xlsx pdf ppt pptx pps ppsx odt ods odp mp3 mov mp4 m4a m4v mpeg avi ogg oga ogv weba webp webm ab1 abi aif aiff app csv dcr dmg epub flv gz html jar jp2 key kml kmz mobi mpg mxd mxp nb nbp pdb pmf prs psd rmd rtf seq sit swf tar tex wav webarchive wma wmv wpd wpf xml zip apk srt.

What text is in the image?:

Enter the characters shown in the image or use the speaker icon to get an audio version.

Office of Immigration Services J-1 Exchange Visitor Info Form

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J-1 Exchange Visitor Info Form