End of J-1 Program Notification to International Student & Scholar Programs

To be completed by the scholar's supervisor:

As required by the U.S. Department of State, program sponsors of Exchange Visitor Programs must report when a J-1 scholar is ending his/her program participation. The following information should be completed, reviewed with the Exchange Visitor, and confirmed before submitting to ISSP (International Student and Scholar Programs). Notification of intent to end participation is required BEFORE the ending date on the Form DS-2019.

Scholar's Last Name:
Scholar's First Name:
Scholar's Date of Birth:
Scholar's Country of Citizenship:

Department Leaving:
Last Date of Official Program Participation:

Please check all that apply:

The scholar has successfully met the program objectives.
The scholar has NOT met the program objectives.
The scholar is leaving the program early.
The scholar has already terminated participation in the program.
The scholar was offered the opportunity to maximize his/her stay to the 3-year limit.
Alternative non-immigrant options to continue program participation were discussed with this scholar (i.e. change of status to H-1B or O-1 visa).
The scholar has been instructed to report to ISSP for an exit interview.

Comments:

Name of person completing this form:
Title:
Email Address: