This online form is not to be used to request a Form DS-2019 for a new J-1 Research Scholar program or an extension. New programs, extensions, and transfer-in requests must be submitted to OIS on the full Request for DS-2019. This form is for department personnel to submit a minor update or amendment for a current J-1 research scholar whose research objectives and basic program remain the same. PIs and Supervisors may use this convenient form without submitting the full form. The changes requested here will be authorized in SEVIS and reflected in the visa Permit Panel page as required. ’s program on the OIS website.
Scholar’s Last/Family Name:
Scholar’s First name:
Scholar’s Campus ID:
Academic Department:
PI/Supervisor’s Last/Family Name:
PI/Supervisor’s First name:
PI/Supervisor’s Email:
Name of person submitting this form:
Effective Date of Requested Change: mm/dd/yy
Type of Update/Amendment (explain below): Add secondary / additional un-paid “Site of Activity” Change in Pay New Supervisor – Same research goals, same department Delayed Begin Date (can be used only if Scholar has not already entered the U.S.) Early Departure/Completion (>30 days before end date on DS-2019) Other:
1. Please enter the complete physical address of the secondary/additional unpaid site of activity (include building, room, street, city, state, zip). If there is a new principal “site of activity” a complete DS-2019 Request Form must be submitted to OIS. The amendment form can be used to add additional (no-pay) sites of activity related to Scholar’s research, observation, and consultation; any payments from secondary/additional sites must be authorized by OIS in advance using the Request for Incidental Employment.
2 . What is the pay-rate change (list amount for remaining period) payable through the department? Note: The amendment form can only be used to reflect a modest increase in pay (<10%) for a Scholar who already has a “pay” appointment. To change a Scholar from “no-pay” to “pay” or to reflect a reduction in a Scholar’s pay a complete DS-2019 Request Form must be submitted to OIS.
3. Who is the new NC State faculty supervisor who agrees to oversee the scholar’s research program?
4. What is the new, revised begin date for this research scholar? Note: The DS-2019 start date can be amended only if the Scholar has not yet entered the U.S. mm/dd/yy
5. What are the circumstances regarding this scholar’s early (>30 days) departure?
6. Additional comments (optional):
