ࡱ> +-* )bjbj΀ 1)      )))))/111111&1   1))F  ))/ /)`{+ .\0C.4Z^@4911qv     : Valdosta State University DS-2019 REQUEST FORM FOR EXCHANGE STUDENTS The following information is needed to prepare the exchange visitor form DS-2019: Full name of the visitor exactly as it appears in the passport: ___________________________________________ Family Name: _______________________________ Given Name: ______________________________ Month of Birth: ___________Date of Birth:________________ Gender: __________________ Year of Birth: ______________________________________ Address: ___________________________ ____________________________________________________________________________________________ Place of Birth City: _________________________ Country: __________________________________ Country of Citizenship: ________________________ E-mail address: ____________________________ Highest level of education achieved: ______________________________________________________________ Please include full name and date of birth of any spouse or children that might be accompanying the visitor. Also include their place of birth, both city and country, as well as country of citizenship. Purpose of visit (circle one): Student Professor Research Scholar Short-term scholar Description and field(s) of lecture/research/study activities while at Ӱý޹˾վ: The proposed dates of stay: (beginning and ending): Have you been in the United States as an exchange visitor (J-1) visa) in the past two years? Yes_____ No _____ If yes, then provide dates of stay and copies of your pervious DS-2019 or IAP-66. After we have received this information, then a DS-2019 form will be issued. You will take this form along with copies of all your correspondence with and documentation provided by Ӱý޹˾վ to the U.S. embassy or consulate to receive a J-1 Visa in your passport. 0GHc h t v w  5 j k "$) hBCJ h{CJ h*gCJ h]qCJ hjCJ hBCJ hjCJhj0FGH  b c   w x 6 7 i j k l $a$l    Q R S !"#$)/ 01/ =!"#$% ^ 666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA D Default Paragraph FontViV  Table Normal :V 44 la (k (No List 0>@0 Title$a$CJPK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] )#)l ) 8@0(  B S  ?̵,V͵Pε,UϵVеѵt ++B*urn:schemas-microsoft-com:office:smarttagscountry-region=*urn:schemas-microsoft-com:office:smarttags PlaceName=*urn:schemas-microsoft-com:office:smarttags PlaceType9*urn:schemas-microsoft-com:office:smarttagsplace +.7+3330Ex+/Fchv5ijQQ"$+*g]qBj f{)+@)@UnknownG* Times New Roman5Symbol3. * ArialA BCambria Math"hx:x:  !d24&&2HX?]q2!xxValdosta State University INFORMATION TECHNOLOGYInformation TechnologyOh+'0 , L X dpxValdosta State University INFORMATION TECHNOLOGY Normal.dotmInformation Technology2Microsoft Office Word@@X+@X+՜.+,0 hp  VALDOSTA STATE UNIVERSITY & Valdosta State University Title  !#$%&'(),Root Entry F˟+.1Table WordDocument1SummaryInformation(DocumentSummaryInformation8"CompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q