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Purpose of the J-1 Program
Fees & Expenses
Program Registration
Host Company Registration
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Evaluations – Midpoint & Final
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Host Company Registration

If you are experiencing any technical problems with submitting the form below, simply email us the information directly to submissions@iieex.net.

Host Company Name

Agency (if any)

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal Code

Employer ID Number

Number of FT Employees Onsite at Location:

Annual Revenue:$0-$3 Million$3-$10 Million$10-$25 Million$25 Million or More

Website

Worker's Comp PolicyYesNo

If yes, name of carrier

Worker's Comp Policy for Exchange VisitorYesNo, exemptNo, but equivalent coverage

Workers Compensation Insurance Policy Provider

Workers Compensation Policy Number

Workers Compensation Policy expiration date

Exchange Visitor Hours per Week

StipendYesNo

If yes, how much

Non-Monetary CompensationYesNo

If no, please explain

Person Of Contact

First Name(can be different from supervisor):

Last Name

Title

Email Address

Phone

Supervisor

First Name

Last Name

Title

Email Address

Phone

Qualifications of Supervisor

Host Company Website

Parent Company (if any)

Parent Company Address

Parent Company Employer ID Number (EIN)

Please summarize your company’s business activities

Total # of full time employees at site of activity

Total # of full time employees company-wide

Total # of J-1 interns or trainees at site of activity including those of other J-1 sponsors

Home OfficeYesNo

Name of Trainee/Intern

Email Address of Trainee/Intern

Training/Internship Start Date

Training/Internship End Date

Training/Internship Field:

Briefly describe the different phases of the training/internship

State at least 5 internship/training tasks

Upload Documents:

Workers Compensation Certificate
Any Other Documents

Upload file

Drag and Drop (or) Choose Files

Consent

I have scheduled the Mandatory Supervisor Interview.