Last Name / Surname (as per passport)
First Name (as per passport)
Middle Name (as per passport)
Date Of Birth (MM/DD/YYYY format)
Place of Birth (As Per Passport)
Country of Citizenship
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Austrian Empire*
Azerbaijan
Baden*
Bahamas, The
Bahrain
Bangladesh
Barbados
Bavaria*
Belarus
Belgium
Belize
Benin (Dahomey)
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Brunswick and Lüneburg*
Bulgaria
Burkina Faso (Upper Volta)
Burma
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands, The
Central African Republic
Central American Federation*
Chad
Chile
China
Colombia
Comoros
Congo Free State, The*
Costa Rica
Cote d’Ivoire (Ivory Coast)
Croatia
Cuba
Cyprus
Czechia
Czechoslovakia
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Duchy of Parma
East Germany (German Democratic Republic)*
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Federal Government of Germany (1848-49)*
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Grand Duchy of Tuscany, The*
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Hanover*
Hanseatic Republics*
Hawaii*
Hesse*
Holy See
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kingdom of Serbia/Yugoslavia*
Kiribati
Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Lew Chew (Loochoo)*
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mecklenburg-Schwerin*
Mecklenburg-Strelitz*
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Namibia
Nassau*
Nauru
Nepal
Netherlands, The
New Zealand
Nicaragua
Niger
Nigeria
North German Confederation*
North German Union*
North Macedonia
Norway
Oldenburg*
Oman
Orange Free State*
Pakistan
Palau
Panama
Papal States*
Papua New Guinea
Paraguay
Peru
Philippines
Piedmont-Sardinia*
Poland
Portugal
Qatar
Republic of Genoa*
Republic of Korea (South Korea)
Republic of the Congo
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Schaumburg-Lippe*
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands, The
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Tajikistan
Tanzania
Texas*
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Two Sicilies
Uganda
Ukraine
Union of Soviet Socialist Republics*
United Arab Emirates, The
United Kingdom, The
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Württemberg
Yemen
Zambia
Zimbabwe
Country of Residence
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Austrian Empire*
Azerbaijan
Baden*
Bahamas, The
Bahrain
Bangladesh
Barbados
Bavaria*
Belarus
Belgium
Belize
Benin (Dahomey)
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Brunswick and Lüneburg*
Bulgaria
Burkina Faso (Upper Volta)
Burma
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands, The
Central African Republic
Central American Federation*
Chad
Chile
China
Colombia
Comoros
Congo Free State, The*
Costa Rica
Cote d’Ivoire (Ivory Coast)
Croatia
Cuba
Cyprus
Czechia
Czechoslovakia
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Duchy of Parma
East Germany (German Democratic Republic)*
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Federal Government of Germany (1848-49)*
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Grand Duchy of Tuscany, The*
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Hanover*
Hanseatic Republics*
Hawaii*
Hesse*
Holy See
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kingdom of Serbia/Yugoslavia*
Kiribati
Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Lew Chew (Loochoo)*
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mecklenburg-Schwerin*
Mecklenburg-Strelitz*
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Namibia
Nassau*
Nauru
Nepal
Netherlands, The
New Zealand
Nicaragua
Niger
Nigeria
North German Confederation*
North German Union*
North Macedonia
Norway
Oldenburg*
Oman
Orange Free State*
Pakistan
Palau
Panama
Papal States*
Papua New Guinea
Paraguay
Peru
Philippines
Piedmont-Sardinia*
Poland
Portugal
Qatar
Republic of Genoa*
Republic of Korea (South Korea)
Republic of the Congo
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Schaumburg-Lippe*
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands, The
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Tajikistan
Tanzania
Texas*
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Two Sicilies
Uganda
Ukraine
Union of Soviet Socialist Republics*
United Arab Emirates, The
United Kingdom, The
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Württemberg
Yemen
Zambia
Zimbabwe
Country code
Mobile Number
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Alternate Contact Number
Email
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Married
Not Married
Have you previously participated in the Exchange Visitor J-visa program or applied to participate? If so, please describe, including when, which category of J program, and your experience.
Have you ever been denied a visa to enter the U.S.?
Yes
No
Have you previously violated any regulations governing a visa you held to come to the U.S.?
Yes
No
Do you have a Social Security Number assigned by the U.S. government?
Yes
No
Unsure
Do you have a Social Security Number assigned by the U.S. government?
Yes
No
Unsure
Address Line1
Address Line2
City
State/Province
ZIP Code
Country
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Austrian Empire*
Azerbaijan
Baden*
Bahamas, The
Bahrain
Bangladesh
Barbados
Bavaria*
Belarus
Belgium
Belize
Benin (Dahomey)
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Brunswick and Lüneburg*
Bulgaria
Burkina Faso (Upper Volta)
Burma
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands, The
Central African Republic
Central American Federation*
Chad
Chile
China
Colombia
Comoros
Congo Free State, The*
Costa Rica
Cote d’Ivoire (Ivory Coast)
Croatia
Cuba
Cyprus
Czechia
Czechoslovakia
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Duchy of Parma
East Germany (German Democratic Republic)*
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Federal Government of Germany (1848-49)*
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Grand Duchy of Tuscany, The*
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Hanover*
Hanseatic Republics*
Hawaii*
Hesse*
Holy See
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kingdom of Serbia/Yugoslavia*
Kiribati
Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Lew Chew (Loochoo)*
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mecklenburg-Schwerin*
Mecklenburg-Strelitz*
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Namibia
Nassau*
Nauru
Nepal
Netherlands, The
New Zealand
Nicaragua
Niger
Nigeria
North German Confederation*
North German Union*
North Macedonia
Norway
Oldenburg*
Oman
Orange Free State*
Pakistan
Palau
Panama
Papal States*
Papua New Guinea
Paraguay
Peru
Philippines
Piedmont-Sardinia*
Poland
Portugal
Qatar
Republic of Genoa*
Republic of Korea (South Korea)
Republic of the Congo
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Schaumburg-Lippe*
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands, The
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Tajikistan
Tanzania
Texas*
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Two Sicilies
Uganda
Ukraine
Union of Soviet Socialist Republics*
United Arab Emirates, The
United Kingdom, The
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Württemberg
Yemen
Zambia
Zimbabwe
Number of years of TEACHING experience
Subject Taught
Grade Taught
PK
K-2
K-6
5-9
6-12
School Name
Start Year
End Year
Country Located
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Austrian Empire*
Azerbaijan
Baden*
Bahamas, The
Bahrain
Bangladesh
Barbados
Bavaria*
Belarus
Belgium
Belize
Benin (Dahomey)
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Brunswick and Lüneburg*
Bulgaria
Burkina Faso (Upper Volta)
Burma
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands, The
Central African Republic
Central American Federation*
Chad
Chile
China
Colombia
Comoros
Congo Free State, The*
Costa Rica
Cote d’Ivoire (Ivory Coast)
Croatia
Cuba
Cyprus
Czechia
Czechoslovakia
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Duchy of Parma
East Germany (German Democratic Republic)*
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Federal Government of Germany (1848-49)*
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Grand Duchy of Tuscany, The*
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Hanover*
Hanseatic Republics*
Hawaii*
Hesse*
Holy See
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kingdom of Serbia/Yugoslavia*
Kiribati
Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Lew Chew (Loochoo)*
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mecklenburg-Schwerin*
Mecklenburg-Strelitz*
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Namibia
Nassau*
Nauru
Nepal
Netherlands, The
New Zealand
Nicaragua
Niger
Nigeria
North German Confederation*
North German Union*
North Macedonia
Norway
Oldenburg*
Oman
Orange Free State*
Pakistan
Palau
Panama
Papal States*
Papua New Guinea
Paraguay
Peru
Philippines
Piedmont-Sardinia*
Poland
Portugal
Qatar
Republic of Genoa*
Republic of Korea (South Korea)
Republic of the Congo
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Schaumburg-Lippe*
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands, The
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Tajikistan
Tanzania
Texas*
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Two Sicilies
Uganda
Ukraine
Union of Soviet Socialist Republics*
United Arab Emirates, The
United Kingdom, The
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Württemberg
Yemen
Zambia
Zimbabwe
Description
Name Of The School You Attended
Degree
Subject / Specialization
Graduation Year
Certifications & Professional Development - Related to teaching only (Please keep your note short and to the point
Skills & Interests - Related to teaching only
Passport First Page
Passport Last Page
First Degree
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