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Home
About Us
Immigration Services
USCIS Processing Times
Visa Bulletin
Immigration Approvals
Immigration News
Blog
中文
Contact Us
info@messersmithlaw.com
+1 305-515-0613
390 N Orange Ave, Suite 2300, Orlando, FL 32801
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J1 Waiver Questionnaire
Questionnaires – Main Page
J1 Waiver Questionnaire
J1 Waiver Questionnaire
For Exchange Visitors
The Messersmith Law Firm Immigration Lawyer Services
We make immigration possible
1. Information about you
Name
First
Middle
Last
Other Names Used 1
First
Middle
Last
Other Names Used 2
First
Middle
Last
Alien Number (USCIS Number or A#)
I-94 Number
Social Security Number (SSN)
Current Address or Last US Address if Outside the US
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Marital Status
Single, Never Married
Married
Divorced
Widowed
Separated
Marriage Annulled
Date of Birth
City / State / Country of Birth
Country of Citizenship
Country of Last Foreign Residence
List all Program Sponsors and Corresponding Program Numbers
Major Field of Activity
Agriculture
Business Administration
Education
Engineering
Humanities
Medicine
Natural and Physical Sciences
Social Sciences
Other
Occupation
Date of Last Entry to US with J1 Visa
Port of Entry of Last Arrival with J1 Visa
J1 Visa Issuing Post (Name of Embassy that Issued Your J1 Visa)
Date of Departure if you left the US
Last Address in the US, if not currently in the US
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Did your exchange visitor program(s) include U.S. Government funds, funds from your own government or funds from an international organization?
Yes
No
Is there any period of time in the US that is not covered by your form DS-2019
Yes
No
Explain Below
Have you ever applied for a J1 waiver before?
Yes
No
What was your case number for the prior application?
2. Information about your spouse
Name
First
Middle
Last
Date of Birth
City / State / Country of Birth
Country of Citizenship
Country of Last Foreign Residence
3. Information about your children
Name 1
First
Middle
Last
Date of Birth 1
Country of Birth 1
Country of Citizenship 1
Country of Last Foreign Residence 1
Name 2
First
Middle
Last
Date of Birth 2
Country of Birth 2
Country of Citizenship 2
Country of Last Foreign Residence 2
Name 3
First
Middle
Last
Date of Birth 3
Country of Birth 3
Country of Citizenship 3
Country of Last Foreign Residence 3
Name 4
First
Middle
Last
Date of Birth 4
Country of Birth 4
Country of Citizenship 4
Country of Last Foreign Residence 4
4. Enter the information of the person submitting this questionnaire.
Name
*
Email
*
Website
Submit