Form DS-3035 J-1 Waiver Recommendation Application

J Visa Waiver
Online (JWOL)

Department of State
Bureau of Consular Affairs

DS-3035 Screen
Mockups

Table of Contents
J1 Waiver Recommendation Process ............................................................................................................ 3
Privacy and Computer Fraud and Abuse Act Notices ................................................................................... 4
How to Use this Web Site ............................................................................................................................. 5
Exchange Visitor Information ....................................................................................................................... 6
Basis Selection............................................................................................................................................... 7
Statement of Reason..................................................................................................................................... 8
Current Address ............................................................................................................................................ 9
Recent Address ........................................................................................................................................... 10
Attorney Address ........................................................................................................................................ 11
Mailing Address........................................................................................................................................... 12
Program....................................................................................................................................................... 13
Non Program ............................................................................................................................................... 14
J2 Visa.......................................................................................................................................................... 15
J1 Visa.......................................................................................................................................................... 16
Verification Summary ................................................................................................................................. 17
Exchange Visitor Packet .............................................................................................................................. 19
EV Packet Download ................................................................................................................................... 20
EV Packet Sample ........................................................................................................................................ 21

J1 Waiver Recommendation Process

Privacy and Computer Fraud and Abuse Act Notices

How to Use this Web Site

Exchange Visitor Information

Basis Selection

Statement of Reason

Current Address

Recent Address

Attorney Address

Mailing Address

Program

Non Program

J2 Visa

J1 Visa

Verification Summary

Exchange Visitor Packet

EV Packet Download

EV Packet Sample

KEEP THIS PAGE FOR YOUR RECORDS
Packet Assembly Checklist - J-1 Visa Waiver Recommendation Application
Use this checklist to organize the pages in the J Visa Waiver Recommendation Application packet

Case Number:
Applicant Name:
Applicant DOB:
Applicant POB:
Waiver Basis:

1667984
sadfsdf dsfdsf
04/22/2000
ANGOLA
Persecution

Check that the exchange visitor's case number and country/region of last residence is written on any documentation submitted, as well as on
the outside envelope of ALL future correspondence with the Waiver Review office.
Packet 1.

Destination: Department of State, St. Louis, MO Please assemble packet in this order:
(Items with a * have been generated in PDF format)

_______

Application fee: Follow the detailed instruction on DS-3035, page 1

_______

Waiver Review Division Barcode Page *: Accompanies the DS-3035

_______

Form DS-3035, pages 1,2 and 3 *: Follow the detailed mailing instructions on page 1. The applicant must sign on line 21. If the form is being
prepared by an attorney, the attorney needs to sign on line 9.

_______

Supplementary Applicant Information pages *: Accompanies the DS-3035

_______

Copy of the data page of the EV's current passport containing name and birth date

_______

Copies of all forms DS-2019 or IAP-66

_______

Statement of Reason *

_______

Self addressed, stamped envelope

_______

Additional items as indicated by the applicant

_______

*** Be sure to sign Form DS-3035, line 21 ***

Packet 2.

Destination: U.S.C.I.S Service Center having jurisdiction over the EV's current place of residence in the United States

_______

Form I-612: obtained from the United States Citizenship and Immigration Services (U.S.C.I.S) office (http://uscis.gov). Carefully read the
instructions for Form I-612 and include all supporting documentation they require.

_______

Third Party Barcode Page *

The Waiver Review Division will forward a recommendation directly to the United States Citizenship and Immigration Services (USCIS).
IMPORTANT NOTE: Once the Waiver Review Division forwards a waiver recommendation to the USCIS, the case is considered closed at the Department of State.
Any further action on the case falls under the jurisdiction of the USCIS. To follow-up on the waiver recommendation, please contact the USCIS Service Center.

DO NOT SEND THIS PAGE. KEEP THIS PAGE FOR YOUR RECORDS

Waiver Review Division Barcode Page
1667984, dsfdsf, sadfsdf, 04/22/2000, POB: ANGOLA, Persecution
1.

2.

3.

20200407114421101

20200407114421201

20200407114421301

Important: Make sure to include this page with your DS-3035

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OMB No. 1405-0135
DS-3035
VERSION No. 07-2008
EXPIRATION DATE 10/31/2020
ESTIMATED BURDEN 1 Hour

U. S. Department of State

J-1 VISA WAIVER RECOMMENDATION APPLICATION
TYPE OR PRINT YOUR ANSWERS IN THE SPACE PROVIDED.
YOU MAY APPEND ADDITIONAL PAGES IN ORDER TO FULLY RESPOND TO THE QUESTIONS
1. Title

Surname (As in Passport)

c Dr. f
e
f
b Mr. f
c
e
c Mrs. f
e
c Ms.
e

dsfdsf

Given Names (As in Passport, First & Middle)

Maiden Name (if any)

sadfsdf

sdfsdf

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)

Gender

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

Apr-22-2000
b Male f
c
e
f
c Female
e
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

rwerweqrw

ANGOLA

THE BAHAMAS

BAHRAIN

5. I am requesting a recommendation for a waiver of the 212(e) requirement based on: (check only one)
f Exceptional Hardship
c
e
b Persecution
c
e
f
c Interested Government Agency (Physician)
e
f
c Interested Government Agency (non-physician)
e
f
c State Health Agency Request
e
f
c No Objection Statement
e
f
6. Did your exchange visitor program(s) include U.S. Government funds, funds from your own government or funds from an international organization?
No
7. Current address of exchange visitor
Street

City

State/Province

Zip/Postal Code

Country (if not U.S.)

fdvdsdfsdf

adfdfgsdf

IDAHO

22222

UNITED STATES OF
AMERICA

Home Phone

Business Phone

Fax

Email Address

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

State

adfdfgsdf

IDAHO

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

City

Business Phone/Ext.

State/Province

Fax

Zip/Postal 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

Country (if not U.S.)
UNITED STATES OF
AMERICA

11. I request that all correspondence, including my recommendation, be sent to my: (check only ONE)
b Current Address (Line 7) f
c
e
f
c Attorney Address (Line 9) f
e
cMailing Address (Line 10)
e
12. List all exchange visitor programs in which you participated, beginning with the first program
SEVIS Number

Program Number

Purpose of the Form

Begin Date
(mmm-dd-yyyy)

End Date
(mmm-dd-yyyy)

Subject/Field Code

Funding Amount

A1111111111

P- 1- 1111

Program Extension /
Continuation

Mar-30-2020

Apr-27-2020

11.1111

$ 111

DS-3035

Page 1 of 2

Supplementary Applicant Information Page (2 of 2)
Case Number:
Name:
Request Type:

1667984
Mr. sadfsdf dsfdsf
Persecution

Visa History
Entry Date of First J-1 Visa:
Entry Port of First J-1 Visa:
Entry State of First J-1 Visa:
Issuing Post of First J-1 Visa:

03/31/2020
4wesd

Program Information
SEVIS ID

Program Number

Purpose

Begin Date

End Date

Subject Field Code

Funding Amount

A1111111111

P-1-1111

Program Extension / Continuation

03/30/2020

04/27/2020

11.1111

$ 111

Dependent Information
Given name

Surname

Date of Birth

Place of Birth

Relationship

Explanation for any period of time in the U.S. not covered DS-2019 or IAP-66 form.

Important: Make sure to include this page with your DS-3035

Status

STATEMENT OF REASON
1667984, sadfsdf, dsfdsf, 04/22/2000, POB: ANGOLA
April 07, 2020
SOR: gyftghfdgd

Important: Make sure to include this page with your DS-3035

THIRD PARTY BARCODE PAGE
Case Number:
Applicant Name:
Applicant DOB:
Applicant POB:
Waiver Basis:

1667984
sadfsdf dsfdsf
04/22/2000
ANGOLA
Persecution

20200407114421401
TO THE USCIS:
1) Please return this page (the Third Party Barcode Page) and the documents listed below to the Department of
State at the address below:
Waiver Review Division
U.S. Department of State
Visa Office
SA-17, 11th Floor
600 19th Street, N.W.
Washington DC 20522-1711
2) Form I-613. Please print the waiver applicant's case file number on both the statement and on the LOWER
RIGHT of the envelope.