Q:\INTERNAL\Handouts and Request Forms\Students\Request Forms\academic_training.doc Updated 1/2020 page 1

J-1 Academic Training (AT) Request Form

DS-2019 Delivery

IMPORTANT INFORMATION ABOUT BIO’S PROCESSING TIME AND DOCUMENT DELIVERYBIO’s processing times are impacted by Alameda County’s shelter in place directive. Most requests will be processed in your SEVIS record in 3 business days, but additional time is required to produce and mail/email your updated document. Your document will be shipped out from our office or emailed to you within 4-7 businessdays of your submission of a complete request. 4-7 business day processing time begins the day after wereceive your request. Your request will be delayed if it is incomplete or requires additional follow-up.

Please choose one delivery option for your new document. Due to a high volume of student requests, we canoffer only one delivery option per request.

Express Mail Enter your order number here (required)*: *You must purchase your own label using ONLY the method described here:http://internationaloffice.berkeley.edu/express_mail

Pick up Pick up your document after the Berkeley International Office reopens. We do not currently know when we will reopen. Please keep in mind that your employer will most likely need to see your DS-2019 when you begin working. Unless your AT start date is very far (many months) in the future, you should not choose this option.

internationaloffice.berkeley.edu

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J-1 Academic Training (AT) Request FormSee eligibility criteria and length of available AT here: https://internationaloffice.berkeley.edu/students/employment/at

*All fields on this form are required. Submit the application for AT to BIO at least 3 working days before: the employment start date,completion of the academic program, or the expiration of your DS-2019. AT authorization will NOT be backdated. Beginning workwithout authorization is a serious violation of status. INCOMPLETE AT applications will result in DELAY OR DENIAL of requested AT.

To request an Academic Training DS-2019, you must submit ALL OF THE FOLLOWING to Berkeley International Office:

• This form completed and signed by you and your Academic Advisor (original signature required).

• Employer Verification Letter. Instructions on template, page 3. Applications with a missing verification letter or with mismatching information on the form and letter will be DENIED.

• Post-Completion AT financial documents showing at least $2,100/month (undergraduate students) or $2,205/month (graduate students). If applicable, additional funding proof for dependents at$880/month for spouse and $776/month per child for the duration of the requested AT period. Salary information from paid job may be used as proof of funding.

• Post-Completion AT Services Fee: See BIO AT webpage for amount and payment instructions. Attach credit/debit card receipt. Credit card payments can be made here: https://io.berkeley.edu/forms/pcfee

Student Information

Family Name: Given Name:

Telephone: Email: Program Completion Date:

Student ID Number: DS-2019 End Date: Previous Academic Training Used (total number of months):

UC Berkeley Major or EAP field of study: Level: Bachelor’s Master’s PhD/Doctoral EAP

Which type of Academic Training are you applying for? Pre-completion (You will not have completed your program before your AT start date)

Post-completion (You will have completed your program by your AT start date)

AT Changes & Evaluation Agreement

I will immediately report any change in my AT employment to BIO. Any changes, extensions, or new employer will require a new AT form in advance.

I understand that employment not matching the exact authorized AT employer, location, duration, hours per week is a serious violation of J-1 status. Pre-completion AT: I will update my LOCAL US address/contact information online via Cal Central: https://calcentral.berkeley.edu/Post-completion AT: I will update my US address/contact information online on the BIO SSU HUB: https://io.berkeley.edu/ssuAt the end of my AT, I will submit a Final Evaluation of my AT experience online through the BIO SSU HUB: https://io.berkeley.edu/ssu

Health Insurance Agreement During my AT period I will be covered by health insurance that fully meets the J-1 requirements for myself and any J-2 dependents with me in the

U.S. for the full length of my stay in the U.S. I understand that failure to do so is a violation of J Exchange Visitor status and would lead to terminationof my Exchange Visitor program and my right to stay in the U.S. I confirm that my insurance and that of any J-2 dependents meets the J studentinsurance requirements found at https://internationaloffice.berkeley.edu/students/current/j-1/insurance

Signature of Student: Date:

Name of J-1 Insurance Provider(s) for full AT period:

Name of J-2 Insurance Provider(s) for full AT period:

Employment Information This information MUST MATCH your Employer Verification Letter EXACTLY or your request will be DELAYED OR DENIED.

Name of Employer (Company Name): Student’s Job Title:

Supervisor’s First and Last Name: Supervisor Title:

Supervisor’s Phone: Supervisor’s Email:

Company Address: City: State: Zip code:

Is this your physical work location? Yes No* (*complete Physical Site of Activity box below)

Physical Site of Activity Name:

Physical Site of Activity Address: City: State: Zip code:

*Hours Per Week: *Begin date: End Date: Total Compensation:

*Post-completion Academic Training must begin within 30 days of your program completion date and be a minimum of 20 hours per week.

internationaloffice.berkeley.edu

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Academic Adviser’s RecommendationJ-1 Academic Training (AT) is training related to a student’s field of study and requires goals, objectives and a clear explanation of how the training is integral or critical to the student’s academic program of study.

This section must be completed with your academic adviser.EAP = College Adviser; Undergrads = Major Adviser; Graduates = Faculty Adviser/Graduate Student Affairs Officer

Describe the academic goals and/or objectives of the student’s Academic Training experience:

Explain how this Academic Training experience directly relates to the student’s current UC Berkeley degree or Education Abroad Program (EAP) field of study:

Explain why this Academic Training experience is an integral or critical part of the student’s academic program:

PhD STUDENTS ONLY - If the student has completed a Ph.D. and is requesting an extension beyond the initial 18 monthsof work authorization, please briefly address the research aspect of the Academic Training experience:

I confirm that I have reviewed and approve the Academic Training Plan as described in this form. If the student isapplying for Post-Completion Academic Training, I also confirm the student will have completed all degree or programrequirements by the start of the AT period, or has only thesis/dissertation remaining.

Adviser Name: Title: Department:

Adviser’s Signature: Date: Adviser Email or Phone:

For BIO use only Payment type: Credit/Debit Check/Money Order

Credit/Debit: Receipt Attached Confirmed by _______________

Check or Money Order # _______________ Payer: Student Other; name: _______________

J-1 Academic Training Verification Letter

Copy ALL TEXT below and print on Employer’s Business letterhead. Completed letter must include all text and provide completed answers to 1-12 (13-14 as needed.)

[Date]

To Berkeley International Office:

This letter is to certify the following J-1 student’s participation in a J-1 Academic Training work-based learning experience. The Employer agrees to provide the student an educational work-based learning experience directly related to their academic program and understands that this work experience is an integral or critical part of the student’s U.S. academic program.

The employer confirms that the work experience 1) consists of bona fide training activities connected to the student’s academic framework, 2) exposes the student to the operations of their field and 3) consists of primarily substantive, skilled roles.

1. Student Full Legal Name: 2. Company Name: 3. Company Address: 4. Student’s Job Title: 5. Detailed Job Description including clear descriptions of student’s role, responsibilities, and duties. (Please attach an

additional page if needed for full job description.):

6. Start and End Dates of Employment: 7. Hours per week: 8. Salary/Wages and frequency (or indicate “unpaid”): 9. Supervisor’s Name (Note: supervisor must not be an F-1 or J-1 student): 10. Supervisor’s Job Title: 11. Supervisor Email: 12. Supervisor Telephone:

* 13-14 required only if Employer name or address differ from physical worksite name and address, or if using 3rd party/staffing company.

13. Student’s Physical Worksite Name*: 14. Student’s Worksite Address*:

[Employer Official Signature- handwritten signature]

[Employer Official Name] [Employer Official Title]

Academic Training (AT) Academic Training is a type of off-campus work authorization for employment or training experience directly related to a J-1 student's field of study. J-1 Academic training:

• is available to J-1 Degree-seeking and Education Abroad Program (EAP) students

• is a type of off-campus work authorization for employment in a student's field of study (not required to be an "academic" job)

• is an an integral or critical part of the J-1 student’s U.S. academic program

• must be authorized by the J-1 student's program sponsor (the institution that issues the DS-2019). Students sponsored by UC Berkeley must request authorization from Berkeley International Office. Students who are sponsored by institutions other than UC Berkeley (such as Fulbright, LASPAU etc.) should check with that sponsor for information on Academic Training eligibility.

Application Deadline

Submit the application for Academic Training to Berkeley International Office at least three (3) working days BEFORE your work experience begins, BEFORE completion of the academic program, and BEFORE the DS-2019 expires. Your degree completion date may or may not be the same as the end date on your DS-2019. The standard processing for all student requests, including AT, is 3 business days (excluding weekends and holidays). Please keep this in mind as you plan your employment start date. Expedites are not available and we are unable to back-date AT start dates. DO NOT begin any employment until AT has been approved and authorized on your DS-2019. Beginning or continuing employment without authorization is a serious violation of J-1 status. Incomplete applications may cause AT to be denied or delayed. “Completion” is defined as:

• Undergraduates – the last day of final exams of the semester you are graduating.

• Graduates – the day degree requirements are fulfilled such as passing final exams or filing a dissertation.

• EAP Reciprocity – the last day of final exams of your last semester in the program.

Instructions for Requesting Academic Training

1. Obtain Health Insurance that meets U.S. State Department J-1 requirements for yourself and ALL J-2 dependents for the duration of the J-1 program, including Academic Training (see below). Failure to maintain sufficient health insurance will result in termination of the J-1/J-2 record.

2. Work with your academic adviser (college, department or faculty adviser) to complete the Academic Training Request Form. EAP Students should also check with their home institution to confirm that post-completion AT will not impact their home country program of study.

3. Submit Academic Training Request Form and required documents and fees to Berkeley International Office. (See page 1.) 4. Pick up your new DS-2019 Academic Training authorization and BIO Academic Training Verification Letter from Berkeley International Office in

3 business days. The letter specifies information about your Academic Training authorization.

A copy of the DS-2019 with the AT annotation and the BIO Academic Training Verification Letter should be given to the employer, and can also be used to apply for a Social Security Number. For information on the Social Security Number application, see http://internationaloffice.berkeley.edu/social_security_application

Health Insurance Agreement

Students using AT must continue to maintain health insurance that meets the U.S. Department of State requirements for J-1 students and their dependents who are in the U.S. for the entire length of stay, including during AT after completion of your program. Required coverage for students and dependents can be found at: http://internationaloffice.berkeley.edu/students/current/j-1/insurance

U.S. Dept. of State Required Health Insurance Coverage for J-1/J-2 Exchange Visitors

Item Minimum requirement

Medical Benefits $100,000 per accident or illness

Repatriation of Remains $25,000

Medical Evacuation $50,000

Deductible per accident or illness $500

• Covers pre-existing conditions after a reasonable waiting period

• Includes a provision for co-payment that does not exceed 25% co-pay by the Exchange Visitor

• Does not exclude benefits for perils inherent to the activities of the Exchange Visitor's program

• Any accompanying spouse and dependent(s) may also be subject to the requirements of the Affordable Care Act. [22 CFR 62.14(a)]

• Any insurance plan must be: o Underwritten by an insurance corporation having an A.M. Best rating of ‘‘A-’’ or above; a McGraw Hill Financial/Standard & Poor’s

Claims paying Ability rating of ‘‘A-’’ or above; a Weiss Research, Inc. rating of ‘‘B+’’ or above; a Fitch Ratings, Inc. rating of ‘‘A-’’ or above; a Moody’s Investor Services rating of ‘‘A3’’ or above; or such other rating as the Department of State may from time to time specify;

o OR backed by the full faith and credit of the government of the exchange visitor’s home country; o OR part of a health benefits program offered on a group basis to employees or enrolled students by a designated sponsor;

o OR offered through or underwritten by a federally qualified Health Maintenance Organization or eligible Competitive Medical Plan as determined by

the Centers for Medicare & Medicaid Services of the U.S. Dept of Health & Human Services