Form DS-7007 Host Placement Certification

U.S. Department of State

SUMMER WORK TRAVEL PROGRAM
HOST PLACEMENT CERTIFICATION

OMB APPROVAL NO.1405-xxxx
EXPIRES: xx-xx-xxxx
ESTIMATED BURDEN: 1.25 hours *

Sponsor Information

PART 1
Name of Sponsor
Sponsor Phone Number
Sponsor Fax Number
Sponsor 800 - Emergency Number

Name and Email Address of Office Responsible for Exchange Visitor (POC)

Name and Email Address of RO/ARO

Exchange Visitor Information
Name (Last, First, MI)
Country of Citizenship
Email Address
Name, Telephone Number, and Email Address of Emergency Contact

Host Entity Information
Name of Host Entity
Street Address
City, State, and Zip Code
Federal Tax ID (EIN) of Organization
Name of President or CEO of Host Entity and Title
Name of Host Entity's Point of Contact
Telephone Number and Email Address of Point of Contact
Privacy Act Statement
Authorities: The information is sought pursuant to Section 102 of the Mutual Educational and Cultural Exchange Act of 1961, as amended (the
Fulbright-Hays Act)(22 U.S.C. 2452) which provides for the administration of the Exchange Visitor Program (J visa).
Purpose: The information solicited on this form is necessary to provide clarity of the Summer Work Travel programs offered to foreign nationals by
United States entities designated by the Department of State to conduct exchange visitor programs, for general statistical use within the Department of
State, and to enable the Department of State to administer effectively the Summer Work Travel category of the Exchange Visitor Program. Failure to
provide the information requested on this form may result in non-participation in the Exchange Visitor Program.
Routine Uses: The information on this form may be used in reviewing complaints and formulating statistical data Summer Work Travel programs
conducted under the Exchange Visitor Program, and may be shared with overseas counterpart offices of the Department of State to ensure proper
administration of this program for exchange purposes. The information provided may also be released to federal, state, local, or foreign government
entities for law enforcement purposes.
Paperwork Reduction Act
*Public reporting burden for this collection of information is estimated to average 1.25 hours per response, including time required for searching existing
data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do
not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this
burden estimate and/or recommendations for reducing it, please send them to ECA/EC, SA-5, Washington, DC 20522-0505.
DS-7007
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Remarks (optional)

DS-7007
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PART 2

Exchange Visitor Placement Information
(For more than one placement, please add sheets.)

1. Job Title
2. Host Placement Location(s)/Sites of Activity/Activities (street address, city, state, and zip code)

3. Hours of Work Each Week

4. Overtime expected?

5. Starting Hourly Wage

6.

Yes

No

Hourly Wage After Deductions and Costs:
Wage Received

Wage Received
7. Is there a training period for which different wages are provided?

Yes

No

8. Training Dates (mm-dd-yyyy)
From
To
9. Host placement in-kind and other benefits, as well as amenities, provided by sponsor(S) or host entity (H).

10. Host placement-related costs to exchange visitor (Please list cost and explanation, including whether cost incurred is sponsor-related(S) or host
entity-related(H).

11. a) Which meals are included at the host site? b) What transportation is available to the host site? (estimated cost weekly to exchange visitor for
both (a) and (b))

Host Placement Description
12. Brief Summary of Entity

13. Brief Summary of Host Placement Duties

14. Physical Demands for Position

15. Drug-Testing Requirements

16. Total Fees and Costs of the Exchange Visitor's Program Charged by the Sponsor, Host Entity, and Sponsor's Third Parties
16(a) Mandatory fees/costs, including deductions for benefits
16(b) Optional fees/costs

17. Total Number of Employees at Host Placement Location

18. Estimated Number of Summer Work Travel Exchange Visitors at the
Host Placement Location

DS-7007 Please use Remarks section on page 2 if more space is needed and indicate the numbers to which the responses apply.
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PART 3

Three Party Certification

Sponsor Statement - I certify that the attached Host Placement Certification is approved and that :
1. Exchange visitor possesses sufficient proficiency in English to participate in the program.
2. Exchange visitor has sufficient finances to support him/herself for his/her stay in the U.S.
3. At a minimum, I will maintain a monthly schedule of personal contact with this exchange visitor.
4. The exchange visitor has a full-time host placement (a minimum of 32 hours per week).
5. I will encourage the cultural goals of the program, fostering exchange visitor contact with the local community; and
6. No payment or incentives were provided to the host entity to place this exchange visitor.

Program Sponsor name
Program Sponsor's Signature (RO)

Program Number
Date (mm-dd-yyyy)

Signatory RO Name (please print)

Host Entity Statement On behalf of _____________________________________ [name of host entity] (the "Host Entity"), I hereby certify as follows:

1. I confirm the accuracy of the information in Host Entity Information and Host Placement Description sections of this
Host Placement Certification for the named Exchange Visitor.
2. With regard to the employment and housing of the named Exchange Visitor by the Host Entity, the Host Entity will
adhere to all applicable regulatory provisions of 22 CFR part 62 that govern the Summer Work Travel Program.
3. The Host Entity will notify the designated sponsor (1) when the named Exchange Visitor arrives at the host
placement site of activity to begin the program; (2) regarding any concerns about, changes in, or deviations from the
particulars of the Exchange Visitor's placement described in this Host Placement Certification; and (3) in the event of
any emergency involving the Exchange Visitor during on the Summer Work Travel Program.
4. I am an officer of the Host Entity and am authorized to make this certification on its behalf.

Host Entity Authorizing Official's Signature

Date (mm-dd-yyyy)

Host Entity Authorizing Official's Name (please print)

Exchange Visitor Statement I hereby acknowledge that I have reviewed, understand, and will follow this Job Placement certification. I will notify my sponsor
promptly if changes occur to my host placement/site of activity, duties, compensation, hours, address where residing in the U.S.,
and/or e-mail address, and if I have added a host placement to an existing one.
Exchange Visitor Signature

Date (mm-dd-yyyy)

Exchange Visitor's Name (please print)

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Housing Addendum
Sponsor or Host Entity Provided Housing Information
1.
2.

Type of Housing:
House
Distance to host placement site of activity.

3.

Transportation provided by host entity?

Apartment

Dormitory

4.

Yes
Specify transportation method to site of activity and cost per week.

5.

Estimated cost of transportation to exchange visitor (Specify Daily, Weekly, or Monthly)

6.

Cost of Housing Per Week to the exchange visitor

Other (specify)

No

7.

Is housing cost determined
weekly or

8.

Is housing cost deducted from exchange visitor wages?
Yes

9.

No

10. Is housing deposit required of exchange visitor?

Yes

monthly?

If part of compensation package
Market value of housing for exchange duration
Market value of transportation for exchange duration
No

Amount?

11. Specify utilities covered within housing cost

12. What utilities must be paid by the exchange visitor and how much for each? (Specify which utility and whether paid weekly or monthly.)

13. Number of other tenants in housing unit that the exchange visitor will occupy?
14. Number of Bedrooms

Share Bedroom

Yes

No

Share with how many others?

15. Number of Bathrooms

Share Bathroom

Yes

No

Share with how many others?

16. Describe Other Housing Amenities Not Noted Above

17. May the exchange visitor change housing options during the period of stay or is there a firm contract for a period of time? Explain-

18. Photos of housing included (optional) -

Exterior

Bedroom

Common Area

Bathroom

Kitchen

19. Housing Acceptance:
Sponsor Signature (RO)

Date (mm-dd-yyyy)

Sponsor Name (please print)

Acceptance of housing by Exchange Visitor:
Exchange Visitor Signature

Yes

No
Date (mm-dd-yyyy)

Exchange Visitor Name (please print)
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