Intern/Trainee Check-in Form

Your Name

Host Company

Supervisor

Telephone number to Supervisor

Your home street address in the U.S.

Apartment number (if applicable)

City

State

Zip Code

Personal cell number in the U.S.

Personal email

Is the expiration date of your visa the same as the end date in box no. 3 on your DS-2019? (Required)
YesNo

If No, please explain:

Did you encounter any problems receiving the J-1 Visa? (Required)
YesNo

If yes, please explain:

Did you encounter any problems at the immigration office or at the customs? (Required)
YesNo

If yes, please explain: