Sample Certification for Exchange Visitors with Clinical or Medical Degrees

Departments should use this template when hosting a J-1 Exchange Visitor who holds a clinical or medical degree and whose program will not involve patient care.

This certification is required to confirm that the exchange visitor's activities are limited to observation, consultation, teaching, or research, in accordance with U.S. Department of State regulations.

Instructions

Before submitting this certification:

• Prepare the letter on official departmental letterhead.
• Replace all placeholder text with the appropriate information.
• Obtain the required signatures from the Department Chair (or designee) and the authorized Dean or Vice President.
• Submit the signed certification to Visa and Immigration Services as part of the J-1 request.

Sample Certification

[Date]

This certifies that the program in which [Exchange Visitor's Full Name] will participate is solely for the purpose of observation, consultation, teaching, or research.

No element of patient care or clinical practice will be involved during the visitor's participation in this program.

Required Signatures

Department Chair

Name: _______________________________________

Department: __________________________________

Signature: ____________________________________

Date: ________________________________________

Authorized Dean or Vice President

Name: _______________________________________

Title: ________________________________________

Signature: ____________________________________

Date: ________________________________________

Visa and Immigration Services

Responsible Officer or Alternate Responsible Officer

Signature: ____________________________________

Date: ________________________________________