Please complete and submit this form to request extended Form(s) DS-2019 for yourself and any accompanying J-2 dependents.
BEFORE YOU BEGIN:
Be sure to have available electronic copies of the following documents, which will need to be uploaded to the form:
- Funding (for Guest Students and Guest Workers only): Evidence of continued exchange program funding through your extended program end date.
- Health insurance: Evidence of continued qualifying health insurance coverage (click here for details) for both J-1 and J-2 dependents:
- Postdoctoral fellows: Please print and attach a copy of your Current Benefits screen in Employee Self-Service (EMS).
- VAIGS students: Please attach a copy of your Priority Health insurance/ID card. If you do not have your card, one can be printed from your MyHealth Insurance page.
- Visiting students and researchers: Please provide proof of coverage through your requested program end date. The proof of coverage must contain the following information:
- Names of all covered persons
- Coverage start and end dates
- Deductible limit (no more than $500 per accident/illness)
- Coverage for accident/illness (no less than $100,000 per accident/illness)
- Coverage for repatriation of remains (no less than $25,000)
- Coverage for medical evacuation (no less than $50,000)
- Coinsurance not to exceed 25%