Federal J-1 Visa regulations require that you complete this evaluation to remain in good standing. In order for us to confirm you have met program requirements, please answer all of the following questions. Completion of all questions, including comments sections is required, and you will not be able to move to the next section without filling in all requested information. Thank you for fulfilling your obligations as a J-1 Visa holder, as outlined in §62.22(l) of the program regulations.

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* 1. Full Name

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* 2. Email Address

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* 3. What is your date of birth?

Date

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* 5. I am a/n:

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* 6. What is your U.S. host company's name?

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* 7. What is your main supervisor's full name?