TEXAS CHRISTIAN UNIVERSITY

 

                                                   REQUEST FOR FORM DS-2019

           (CERTIFICATE OF ELIGIBILITY FOR EXCHANGE VISITOR [J-1] STATUS)

 

Please complete this form, attach a copy of the recommendation for appointment (if it has not already been processed), and forward them to the Provost/VC Academic Affairs, TCU Box 297040.

 

Visitor's Name:

                                    (last)                    (first)                    (middle)

 

Visitor's Current mailing address: 

 

 

Date of birth: Place of Birth:

                                month               day      year                                                (city & country)

 

 

Citizen of:  Legal Permanent Resident:

                                (country)                                                                                                 (country)

Visitor's position in home country is:

 

 

Dates for TCU appointment/visit will be from to

 

The specific field of study, research, or professional activity at TCU will be:  

 

 

Financial Support provided by TCU for this Exchange Visitor is $ .


Financial support provided from other sources for this Exchange Visitor is $.

 

Source(s):

 

 

Does Exchange Visitor intend to bring any family members with him/her? yes     no

 

If so, whom? 

        Name                                  Relationship            Place of Birth            Date of Birth                Nationality

        Name                                  Relationship            Place of Birth            Date of Birth                Nationality

        Name                                  Relationship            Place of Birth            Date of Birth                Nationality

 

Remarks:

 

Faculty Member or Department Chair:

 

TCU Department:

 

 

Provost 1/03

DS-2019req.doc