J-1 Department Head/Chair Confirmation Form

  • Campus Information

  • Department Head/Chair Information







  • Visiting Scholar Information

    I acknowledge that the below named individual has been invited to participate in academic activities with my department.






  • 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 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.