J-1 Academic Training Request Form

Name*
First Last
UMW E-mail*
Employer Name*
Location of Employment*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Position Title*
Duties of the employment/training*
Employment/Training Dates (Start Date and End Date)*
Number of Hours Per Week*
Academic Training's Relationship to Coursework*
Is the employment/training directly relate d to your academic program /coursework at UMW (it must be related to at least 2 courses you have taken or are currently taking while at UMW) ?
- Yes
- No
How does this employment/Academic Training contribute to your academic program? To which 2 courses is your Academic Training related?*

Name*
First Last
UMW E-mail*
Employer Name*
Location of Employment*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Position Title*
Duties of the employment/training*
Employment/Training Dates (Start Date and End Date)*
Number of Hours Per Week*
Academic Training's Relationship to Coursework*
Is the employment/training directly relate d to your academic program /coursework at UMW (it must be related to at least 2 courses you have taken or are currently taking while at UMW) ?
- Yes
- No
How does this employment/Academic Training contribute to your academic program? To which 2 courses is your Academic Training related?*