VLI DS-2019 Request Form

DS-2019 Request Form

The DS-2019 Certificate of Eligibility for J-1 Exchange Visitor Status is the form you will use to apply for your visa. All DS-2019 Forms will be sent electronically to the email provided.

Biographic Information
This information is required to issue your DS-2019 Certificate of Eligibility for Exchange Visitor Status (J-1 Non-Immigrant). Please enter your information accurately. ALL DS-2019 Forms will be sent electronically to the email provided.
Name*
Enter your name as it appears on your passport.
First/Given Name Middle Last/Surname
Gender*
- Female
- Male
Date of Birth*
Month
Day
Year
Place of Birth*
City Country
Citizenship*
Select your country of citizenship.

Country
Country of Legal Residence*
Select your current country of legal residence.

Country
Home Country Mailing Address*
Street Address Address Line 2 Country
Phone*
Email*
Enter your current e-mail address.
Mandatory Accident & Illness Insurance
The United States Department of State requires J-1 Exchange Visitors to have accident & illness insurance for the duration of their program dates. The estimated cost of insurance is based on your age. The cost is estimated at $600 for the academic year, if you are 24 years of age or younger. For VLI and VLCs: the cost of insurance will be covered by the Department of Modern Languages and Literature, as outlined in your contract. If you plan to remain in the U.S. after your program end date, it is highly advised you purchase additional insurance. If you would like to continue your dates of coverage, email CIE for instructions. Please be advised that insurance coverage extending beyond your official program dates will NOT be covered by UMW.
Emergency Contact Information
Please enter the name and contact information for the person you would like us to contact in case of emergency.
Primary Emergency Contact Name*
Contact's Relationship to You*
Emergency Contact's Phone Number*
Emergency Contact's E-mail Address*
Personal Expenses
Although most of your expenses are covered per the terms of your contract, you will be responsible for personal expenses such as, airfare, university meal plan, medical expenses not covered by insurance, and personal travel expenses. As such, we require you to submit proof of finances in the amount of $500 US dollars minimum.
Meal Plan*
A meal plan for the University Center dining facilities is required. Prices below cover meal plans for the academic year (2 semesters). Please choose one: Note: plans and cost subject to change, visit umw.sodexomyway.com/my-meal-plan for more information.
- 225 Meal Plan $4,746
- 150 Meal Plan $4,553
- 85 Meal Plan $2,558
Personal Allowance*
- Academic Year $800
- One Semester $400
For VLIs/VLCs: although most of your expenses are covered per the terms of your contract, you will be responsible for personal expenses such as, airfare, university meal plan, medical expenses not covered by insurance, and personal travel expenses. As such, we recommend a personal allowance in the amounts listed above.
Total Estimated Cost
Price: $0.00

DS-2019 Request Form

Biographic Information

Mandatory Accident & Illness Insurance

Emergency Contact Information

Personal Expenses

Center for International Education