Name (as indicated on your passport)

Have you already signed up for BelCham Young Individual Membership? *

Enter required value Yes No

Email

LinkedIn Page

LinkedIn profile URL

Permanent Address *

Street, number

City/Town

Zip code

Region

Country

Phone

Birthdate (Month, Day, Year)

Emergency Contact Name *

How are you related to them? *

Emergency Contact Email *

Emergency Contact Phone

Emergency Contact Address *

Intended Internship/Traineeship Start Date

Intended Program Duration

Up to 6 months 6-12 months 12-18 months (if eligible as a Trainee)

Copy of Passport *

Files must be less than 5 MB.

Allowed file types: pdf.

20MB max

Letter of Reference 1

-Must be in English

-be on company or university letterhead and signed by the person providing the reference

-be signed and dated within the last 12 months

-include complete contact information of the person providing the reference

-must confirm your dates of employment and whether you worked full time or part time (if a job reference)

-must speak to your suitability to pursue training in the USA (should attest to your work ethic and/or skills - For trainees: should indicate the hours worked per week.)

-Files must be less than 500KB

-allowed file types: pdf, doc

20MB max

Letter of Reference 2

-Must be in English

-be on company or university letterhead and signed by the person providing the reference

-be signed and dated within the last 12 months

-include complete contact information of the person providing the reference

-must confirm your dates of employment and whether you worked full time or part time (if a job reference)

-must speak to your suitability to pursue training in the USA (should attest to your work ethic and/or skills - For trainees: should indicate the hours worked per week.)

-Files must be less than 500KB

-allowed file types: pdf, doc

20MB max

Resume

Must include your graduation date or projected graduation date.

If your graduation date is not yet set, please estimate it to the best of your ability. Projected graduation date must be in the format of month/day/year. An exact date is required.

For all positions and educational experiences on your resume there should be a clear month and year corresponding to the start and end date for each experience. (For example, mm/yyyy - mm/yyyy or mm/yyyy - Present).

Files must be less than 1 MB.

Allowed file types: pdf.

20MB max

Degree/Letter of Enrollment

Please provide current semester proof of enrollment. Please share the original document and the official translation.

Please provide your most recent diploma or other confirmation of graduation. 

If an English version is not available, an online translation service such as Rush Translate (www.rushtranslate.com) or ASAP Translate (www.asaptranslate.com) may be used. 

20MB max

Transcript

20MB max

Copy of Medical Insurance

All documentation must be submitted in English. Please either ask your provider for a letter in English or send the French version to a translator. Online services such as Rush Translate or ASAP Translate are permitted. You cannot translate the document yourself. 

- Your full name 

- Start/End date of insurance coverage (covering you for your entire stay in the USA)

- Policy Number

- Proof of Medical benefits of at least $100,000 per accident or illness (if unlimited or a different amount must state so)

- Proof of Repatriation of remains benefits in the amount of $25,000 (if unlimited or a different amount must state so)

- Proof of coverage for Expenses associated with the medical evacuation of the exchange visitor to his or her home country in the amount of $50,000 (if unlimited or in a different amount must state so)

- A deductible not to exceed $500 per accident or illness. (if there is no deductible, or the deductible is a different amount, your documentation must state this)

- many policy providers will only allow you to purchase insurance up to 364 days

Insurance minimums are set by the US Federal Government and as such, BelCham cannot make any exceptions. Proper insurance and documentation is a required condition of your application. 

Link here to Vorbach, BelCham's trusted provider for J-1 insurance policies (the process can be completed in a few minutes) 

20MB max

Host Company Name

Host Company Supervisor - Name (First, Last)

Host Company Supervisor/Contact email

Proof of Language Proficiency (File upload)

Please upload if applicable.

20MB max

Financial Security Statement

Please check the applicable box:

If stipend will be less than $1,500 per month you will have to show evidence that you will be able to support yourself financially ‐ you will be asked to fill out and attach the documents here. This is demonstrated through the following documents (1 AND 2):

1: Letter from the Account Holder: Signed letter from the account holder (you or your guarantor) stating $X,XXX of the amount listed on the bank statement (document No. 2a) will be for the intern/trainee’s J1 program.

2: Bank Statement (a printed record of the balance in a bank account with the account holder's name) showing funds in the account proving the statement in the above letter is true.

Financial Security Statement

Financial Security Statement -Gaurantors

Stipend from host company will be $1500 per month or greater Stipend from host company will be under $1500 per month

Financial Secuirty Document

If applicable, please upload the Financial Security document here.

20MB max

Have you previously visited the U.S. on a J-1 Visa

Yes No Other

Are you a citizen or permanent resident of any other countries? *

If yes, please indicate which country.

In the last 12 months, have you visited the U.S.? *

Enter required value Yes No

If yes, what was the purpose of the visit, and the type of visa you held?

I affirm that I meet all the requirements for a J1 internship or traineeship. *

I affirm that I meet all the requirements for a J1 internship or traineeship. I understand the administrative fees and program fees and expenses outlined by BelCham. By answering yes, I agree to all points below:

• BelCham is a non-profit, international education exchange organization authorized by the United States Department of State to sponsor program participants under the Exchange Visitor (or type “J”) Visa. This authorization allows a trainee a maximum of 18 months and interns a maximum of 12 months in the United States for practical training/internship. Individuals with a J-1 Visa have only 30 days beyond the training/internship program termination date to remain in the United States. You and your dependents will then be expected to exit the United States. However, BelCham can withdraw sponsorship if any of the conditions of your training/internship are changed without BelCham’s written permission in advance. If sponsorship is withdrawn, you must return your DS-2019 and exit the country immediately. BelCham is your legal sponsor throughout the duration of your program. Your training entity is not your sponsor. It is imperative that you discuss any intended changes in your training program with BelCham. All communication must come directly from you and not via any third party.
• Please read the following statement carefully before confirming below:
  1. I understand that the time allowed for practical training employment is limited to a maximum of 18 months and to a maximum of 12 months for practical internship.
  2. It is not my intention to abandon my permanent residence in another country.
  3. I understand that BelCham is my legal sponsor, and I agree to consult directly with BelCham before attempting to change any aspect of my status.
  4. I certify that I will follow any instructions from BelCham before and during my stay in the United States, and I will comply with applicable laws, regulations, and/or instructions of appropriate government agencies in the United States.
  5. I understand that I may be subject to a two-year home-country residence requirement if my course of training is contained in the State Department’s list of needed knowledge or skills in my home country or if I have received governmental Funds.
  6. I certify that the information given in this application is complete and accurate.