J-1 Department Head/Chair Confirmation Form

Campus Information

Department Head/Chair Information

Verification of Department Head(Required)
Department Head/Chair Name(Required)

Visiting Scholar Information

I acknowledge that the below named individual has been invited to participate in academic activities with my department.
Visiting Scholar Name(Required)

Attestations

The purpose of the Exchange Visitor Program, as administered by the U.S. Department of State (DOS) and the Department of Homeland Security (DHS), is to promote international educational exchange. Host departments have responsibilities for the selection and monitoring of Exchange Visitors. The Chair of the host department and the Principal Investigator/Visiting Scholar Supervisor must read and agree to statements below and demonstrate that agreement by signing this attestation. By signing, the host department attests that it will comply with DOS and DHS regulations. You must read each statement and acknowledge you understand the statements herein.
I will notify the Responsible Officer or Alternate Responsible Officer within the Center for Immigration Services and Support (or at the Health Sciences/Bowman Gray Campus) in advance of any proposed changes to the Visiting Scholar's program, including, but not limited to: change to start date due to arrival delays, funding, activities, sites of activity, extended periods of travel exceeding 30 days, and date of termination/program completion, to determine if such changes are permissible(Required)
I will notify the Responsible Officer or Alternate Responsible Officer within the Center for Immigration Services and Support (or the Health Sciences/Bowman Gray Campus) when a visiting scholar is no longer making progress towards their program objectives.(Required)
I will notify the Responsible Officer or Alternate Responsible Officer within the Center for Immigration Services and Support (or the Health Sciences/Bowman Gray Campus) if the Visiting Scholar will end program participation earlier than the program end date listed on the Visiting Scholar's Form DS-2019 so that their record can be shortened.(Required)
I will notify the Responsible Officer or Alternate Responsible Officer within the Center for Immigration Services and Support (or the Health Sciences/Bowman Gray Campus) immediately of any investigations of a Visiting Scholar’s site of activity or serious problem or controversy that could be expected to bring the Department of State, the Exchange Visitor Program, or Wake Forest University's J program into notoriety or disrepute, including any potential litigation related to WFU's J program in which WFU or the Visiting Scholar may be named a party, so that DOS can be notified on or before the next business day as required.(Required)
The department will strive to make a variety of appropriate cross-cultural activities available to the Exchange Visitor and his or her dependents, and to encourage the voluntary participation in these activities. I understand that the participation in cross-cultural programs by and the accomplishments of Visiting Scholars can be shared with the Responsible Officer for Wake Forest University's J Program, so that they can be included in the annual report on the J program to the Department of State.(Required)
The J-1 exchange visitor will be provided adequate supervision from the faculty sponsor and/or yourself during their entire stay.(Required)
The department understands it is their responsibility and agrees to provide adequate resources to the visiting scholar to successfully complete their program activities (space, library access, building access, etc.).(Required)
Name(Required)
I have read and hereby agree to the attestations above and will comply with the DOS and DHS requirements for the duration of the program requested on the Form DS-2019. By signing my name below, I understand that I must cooperate with any inquiry or investigation undertaken by DOS or DHS. I certify, under penalty of perjury, that this application and the evidence submitted with it are true and correct to the best of my knowledge.

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