Participant Name: Host Employer:
IEE, INC is dedicated to increasing international understanding and cooperation through meaningful training and internship programs and cultural experiences sponsored by IEE, Inc.. In order to monitor your training progress and welfare, and to ensure the continued quality of our training and intern programs, IEE, Inc. conducts periodic program evaluations. The information collected will be used to assess the quality of your program and to improve the programs and services offered to IEE, Inc’s. participants. All trainees and interns are required to participate in the evaluation process. If you have any questions regarding evaluations, evaluation forms, or program requirements, contact your visa sponsor, IEE, Inc.
I certify that I have received and understand the Program Welcome Packet, which includes the following:
• J-1 Program Handbook
• Health Insurance Information
• United States Department of State Exchange Visitor Welcome Brochure
• IEE Orientation explaining the rules governing the program, as per Exchange Visitor Program Regulations (22 CFR Part 62).
I certify that I have access to a copy of my signed training plan, which includes a written summary of the training objectives and all significant components of my program, a description of my expected living expenses and a statement of wages, if any, I am to be paid during my participation.
I certify that I have read the J-1 Program Handbook, which contains information on the following:
• The purpose of the J-1 Exchange Visitor Program
• A description of the J-1 Program
• Instructions for travel and entry into the United States
• Instructions for locating and securing housing (If not provided by your host employer)
• Expected living expenses and other costs I will likely incur during my program
• Life and customs in the United States
• How to access Local Community resources and public services
• Available healthcare, emergency assistance, and insurance coverage
• Safety information
• Rules and guidelines that I am expected to follow while participating in the J-1 Program sponsored by my visa sponsor, IEE, Inc.
• Emergency contact information for my visa sponsor, IEE, Inc.
• Address and telephone number of IEE’s Responsible Officer (to be used for ANY and ALL issues related to your exchange visitor program).
• Address and telephone number of Exchange Visitor Program Services of the United States Department of State.
I certify that I understand and agree to the following:
• I am subject to all of the laws of the United States as well as the State where I am residing during my training. Additionally, I am responsible for following all rules and policies of my host company, and all policies of my visa sponsor, IEE, Inc. as described in my J-1 Program Handbook.
• I must train with the same host company through the duration of my program. I understand that I may not leave my host company or transfer to another host organization without prior express written permission of my visa sponsor, IEE. Failure to do so will result in immediate termination of my program and I will have to return to my home country immediately. Additionally, I may not accept any secondary employment while participating in this program.
• I am responsible for informing IEE, Inc. of my physical residential address within 72 hours of my arrival to the United States. Additionally, I acknowledge that if my physical living address changes, I must inform IEE within 3 business days.
• I understand that once in the United States, my first point of contact is IEE. I am to contact them with any issues related to my J-1 program.
By submitting this form, I am acknowledging that I have been provided with the above information, that I have read and understand what has been provided to me to support my program while in the United States and that I will abide by all program regulations.