Log in and this form will be prefilled with your profile data (like email address and default department).

Please see Procedure Overview at the bottom of this form for instructions and next steps.    

Required fields are shaded yellow and marked with a red asterisk.                                   

Triage Information
Extensions are only granted for internships that were originally less than 12 months, and the extension cannot make the internship length more than 12 months.
Please note:Interns may enter the U.S. up to 30 days before the start date BUT may not enter the US after the start date listed on the DS-2019. When in doubt, choose a later start date.
You may request a length of stay up to four quarters (12 months). Intern must depart the U.S. no later than 30 days after the end date. The required registration fee and the optional health insurance and UPass fees are charged on a quarterly basis and can’t be prorated.
Department and Budget Information
A confirmation will be sent to this address.
To be used for associated visa and FedEx fees.
(Format: xxx-xxx-xxxxxx)
Visit Information
Supervisor Information
The supervisor is a current UW faculty member in the host department or program that oversees and mentors the Intern, prepares and assures that the Training/Internship Placement Plan is closely followed, provides the intern with quarterly performance evaluations, assures that the intern is continuously involved in work-based learning and assists in achieving the stated objectives. The supervisor must have a title from the list below. Affiliate and Visiting faculty are not eligible. The supervisor may be assisted by others who interact with the intern, but the supervisor must not delegate supervisory authority to others.
Required by ISO, effective 3/14/14.
Attachments

Remember to click the "Upload" button after selecting the document.  Do not attach documents that contain sensitive data such as SSN.

Files must be less than 2 MB.
Allowed file types: txt rtf pdf doc docx xls xlsx.
Files must be less than 2 MB.
Allowed file types: txt rtf pdf doc docx xls xlsx.
Files must be less than 2 MB.
Allowed file types: txt rtf pdf doc docx xls xlsx.

Submission of this form serves as confirmation that pertinent approvals are on file in department.

Procedure Overview

  1. Intake form is completed by unit administrative staff.  Submitter receives confirmation email, including FMRT ("RT") ticket number.  All further correspondence regarding the request occurs through RT.
  2. Shared Services contacts the visitor for further information and works with the department, visitor, and VISIT Office to complete the application process.  Please note: The VISIT Office now requires that complete applications be submitted 12 weeks prior to desired date of issuance of the DS-2019. 

 

 

What happens next

Relevant Services: