Form DS-3035 J-1 Visa Waiver Recommendation Application

U. S. Department of State

J-1 VISA WAIVER RECOMMENDATION APPLICATION INSTRUCTIONS

Keep this page for your records
Complete the following two pages of this form and send them, along with the fee
and supporting documentation listed below, to:
U.S. Department of State
Waiver Review Division
P.O. Box 952137
St. Louis, MO 63195-2137

PLEASE DO NOT STAPLE ANY DOCUMENTS
PLEASE AVOID TWO-SIDED DOCUMENTS AND ONLY USE 8 1/2" X 11" PAPER
Supporting documents and fee
1. Application fee of $215 PER J-1 APPLICANT. Please send a cashier's check or money order in U.S. currency
drawn on a U.S. bank, made payable to THE U.S. DEPARTMENT OF STATE. Include your name, date and
place of birth on whatever form of payment you submit. DO NOT SUBMIT MORE THAN ONE APPLICATION
FEE PER PERSON.
2. Any additional pages needed to full respond to the questions in this form.
3. A statement demonstrating why the exchange visitor is eligible to receive a waiver of the two-year home
country requirement of the exchange visitor program. The length of the statement may vary.
4. Copies of all DS-2019 "Exchange Visitor Program Certificate Of Eligibility For Exchange Visitor (J-1)
Status" (formerly IAP-66) forms.
5. Notice of Entry of Appearance as Attorney or Representative (G-28 form), if the exchange visitor is
represented by an attorney.
6. Copy of the data page of the exchange visitor's current passport containing name and birth date.
7. Two self-addressed, stamped envelopes.

Once your application has been processed, you will receive your case number and further instructions on how
to proceed. Please do not call to verify that the application has arrived. Current processing times are listed on
the U.S. Department of State web site, www.travel.state.gov.

PAPERWORK REDUCTION ACT
*The response time is an estimated average including the time needed to look for, get, and provide the information
required. You do not have to provide the information requested if the OMB approval has expired. We would appreciate
any comments on the estimated response and cost burdens, and recommendations for reducing them. Please send your
comments to: U.S. Department of State (A/ISS/DIR) Washington, DC 20520.
DS-3035
xx-xxxx

Instruction Page 1 of 1

U.S. Department of State

J-1 VISA WAIVER RECOMMENDATION APPLICATION

OMB No. 1405-0135
EXPIRATION DATE:xx-xx-xxxx
ESTIMATED BURDEN: 1 Hour

TYPE OR PRINT YOUR ANSWERS IN THE SPACE PROVIDED.
YOU MAY APPEND ADDITIONAL PAGES IN ORDER TO FULLY RESPOND TO THE QUESTIONS
1. Title
Dr.

Surname (As in Passport)
Mr.

Mrs.

Ms.

Given Names (As in Passport, First and Middle)

Maiden Name (If Any)

Please indicate any other names that you are, or have been, known by. These can include aliases, previous
married names, religious names, professional names, etc.
Other Surname(s)

Other Given Name(s)

3. Date of Birth (mmm-dd-yyyy)

2. Gender
Male

Female

4. Country Information (As shown on your most recent DS-2019/formerly IAP-66.)
City of Birth

Country of Birth

Citizenship Country

Legal Permanent Residence Country

5. I am requesting a recommendation for a waiver of the 212(e) requirement based on: (Check Only One)
Exceptional Hardship

Persecution

Interested Government Agency (Physician)

Interested Government Agency (non-physician)

State Health Agency Request

No Objection Statement

6. Did your exchange visitor program(s) include U.S. Government funds, funds from your own government or funds from an international
organization?
7. Current Address of Exchange Visitor
Street

City

State/Province

Home Phone

Business Phone

Facsimile

ZIP/Postal Code

Country (If Not U.S.)

Email Address

8. Last U.S. city and state, if not currently living in U.S.
City

State

Yes
No
9. Are you represented by an attorney or other organization?
(If yes, please enter the following information about his attorney or organization.)
Attorney, Representative, and/or Organization Name

Street

City

Business Phone/Extension

State

Facsimile

ZIP Code

Email Address

If this form is being prepared by an attorney, the attorney must sign here.
10. Mailing Address of Exchange Visitor (If different from your current or attorney address.)
Street

City

State/Province

ZIP/Postal Code

11. I request that all correspondence, including my recommendation, be sent to my: (Check Only One)
Current Address (Line 7)
Attorney Address (Line 9)

Country (If Not U.S.)

Mailing Address (Line 10)

12. List all exchange visitor programs in which you participated, beginning with the first program.
SEVIS Number

DS-3035
xx-xxxx

Program Number Purpose of the Form

Begin Date
(mmm-dd-yyyy)

End Date
(mmm-dd-yyyy)

Subject/Field Code

Funding Amount

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13. Is there any period of time in the U.S. that is not covered by your form DS-2019/formerly IAP-66?
Yes (If yes, please explain below.)

No

14. Does this application include any J-2 dependents?
Surname

Given name

15. Is your spouse in J-1 status?

Yes (If yes, please enter information about these J-2 dependents below.)
Date of Birth
(mmm-dd-yyyy)

Country of Birth

Yes (If yes, he or she must apply separately for a waiver.)

No

Relationship

No

16. If your spouse has applied for a waiver, please enter information about his/her J waiver case below:
Surname

Given name

Date of Birth
(mmm-dd-yyyy)

Country of Birth

J Waiver Case Number

17. Date and place of first entry into the U.S. on your original exchange visitor (J-1) visa. Entry information should refer to the first time the
J-1 visa was used to enter the U.S. If the EV changed to J-1 visa status while already in the U.S., enter the date of status change,
control number and issuing post of that first J-1 visa.
Date (mmm-dd-yyyy)

Port of Entry

Visa Control Number

State of Entry

18. Alien Registration Number, if any

Issuing Post

19. I-94 Number

A

20. If you have ever applied for a J visa waiver recommendation or advisory opinion, please enter your most recent case number
21. I certify that I have read and understood all the questions set forth in this application and the answers I have furnished are true and
correct to the best of my knowledge and belief. I understand that any false or misleading statement may result in the refusal of a waiver
recommendation.
Signature of Exchange Visitor

Date(mmm-dd-yyyy)

DO NOT WRITE BELOW THIS SPACE - FOR OFFICE USE ONLY
Case Number

DS-3035

Date Received

Fee Paid

G-28

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