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Acknowledgement of Fees You Paid for Participation in the J-1 Program

This form will provide evidence that all IEE’s J-1 participants are aware of all fees that are to be paid for the participation in the exchange visitor program. Please report all fees paid in relation to this exchange visitor program as listed below:

Fee paid to Agency in home country:    USD

Fee paid directly to IEE:                         USD
(if not using an agency in your home country)  

Fee paid for insurance:                         USD

Fee paid for SEVIS:                              USD

Fee paid for the visa application:          USD

Fee paid for travel to the U.S.:              USD

Please list any other fees you have paid related to participation in this program that is not listed above: USD   


What are these fees to cover? 


Your Name:

Home Country Agency Name (If applicable): 

Placement location: 

If your visa is denied at the embassy, you will receive a 50% refund of your program fees and all of your insurance fees that were paid to IEE provided that your original DS-2019 form is returned to our office within 10 business days of your denial. 
If your program is cancelled or you withdraw prior to the issuance of the DS-2019 fee, you will be charged a $250.00 cancellation fee.  If your program is cancelled or you withdraw after your DS-2019 form has been issued, you will be charged a $500.00 cancellation fee.   DS form must be returned within 10 days of cancellation in order to receive a refund.  These fees do not include any fees that may be charged by your agency in your home country, if applicable.

Note:  Under no circumstances will refunds be issued once you have entered the country

Below are additional fees that may be applicable during your program:

DS-2019 replacement fee: $250.00
​If your visa is denied and you would like to reapply, there will be a $250.00 charge to re-submit your documents to include shipping
Transfer Fee (Transfers are not guaranteed and are not to be expected, but handled on a case by case basis): $350.00
Travel Validation: $50.00
Extension Fees: $750.00 + insurance


By hitting the submit button, you are certifying that the rates above are correct to the best of your knowledge and that you are acknowledging our visa denial fee and any additional fees that IEE may charge you as it relates to your program.



$180.00
$160.00