About OverviewTraining & InformationNoncomplianceFAQsGlossary of TermsFormsContact Export Control Foreign Travel Foreign Travel Process and GuidelinesForeign Travel Form Exchange Visiting Scholars Program General InformationInterest FormAcademic & Immigration Review ApplicationApplication InstructionsEnglish Language Proficiency AssessmentStatement of Compliance with Exchange Visitor Health Insurance Requirements Form Related Areas Office of Research ComplianceOffice of Research and Sponsored ProgramsGraduate SchoolTechLaunch Exchange Visiting Scholar Program: Academic & Immigration Review Application UA Little Rock Departmental InformationHost Faculty Name(Required)Host Faculty Department(Required)Host Faculty Email Address(Required) Enter Email Confirm Email Who will be the UA Little Rock point of contact for the application process?(Required) The hosting faculty member Another UA Little Rock faculty/staff member Point of Contact's Name(Required)Point of Contact's Email Address:(Required) Enter Email Confirm Email Host Department Chair:(Required)Chair's Department(Required)Chair's Email Address:(Required) Enter Email Confirm Email Dean of Hosting Department:(Required)Dean's College(Required)Dean's Email Address:(Required) Enter Email Confirm Email Visiting Scholar's Personal InformationFamily Name/Last Name:(Required)First Name:(Required)Other Names Used:(Required)Date of Birth(Required)Current Email Address:(Required)Current Mailing Address:(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country If your country does not utilize ZIP / Postal Codes, enter ‘00000’ in order to complete the form.Address on U.S. Driver's License, if they have one: Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Current Phone Number(s):(Required)Gender:(Required) Male Female Marital Status:(Required) Married Unmarried Visiting Scholar's Citizenship InformationCity of Birth:(Required)Country of Birth:(Required)Country of Permanent Residence:(Required)Country of Citizenship:(Required)Does the visiting scholar have a dual citizenship?(Required) Yes No If yes, please explain.(Required)Visiting Scholar's Accompanying Dependent(s)Will any immediate family members be joining the visiting scholar?(Required) Not at this time. A spouse will be joining the visiting scholar. One or more unmarried children under the age of 21 will be joining the visiting scholar. Dependent Disclaimer(Required)Please note that, according to U.S. immigration laws and the Exchange Visitor Program, only one spouse may accompany the visiting scholar as a dependent. Additionally, only unmarried children under the age of 21 may accompany the visiting scholar as dependents. For every dependent that accompanies the visiting scholar, the required health insurance will increase in price. I understand and will communicate this information to the visiting scholar. Dependents' Passport ID Pages(Required) Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 1 MB. Visiting Scholar's Professional InformationAcademic Field:(Required)Current Occupation:(Required)Employer/Institution in Country of Permanent Residence:(Required)Visiting Scholar's CV or Resume(Required) Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 1 MB. Copy of Passport ID Pages(Required)Please attach a copy of the visiting scholar’s passport ID page, as well as a copy of the passport ID pages for all accompanying dependents. Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 1 MB. J Visa Program InformationWhen will the visiting scholar's J program begin?(Required) MM slash DD slash YYYY Note: This section is NOT asking for the visiting scholar’s travel dates, but for their proposed dates of research at UA Little Rock. Visiting scholars can enter the U.S. 30 days before and stay 30 days after J program dates. When will the visiting scholar's J program end?(Required) MM slash DD slash YYYY See note on the previous question for important details.Which J category will the visiting scholar be?(Required) Research Scholar Professor Short Term Scholar Student Intern There are three main categories for J visas. 1. Research scholar: the visiting scholar’’s primary activity will be research. The maximum time allowed in the U.S. on this visa is five years. 2. Professor: the visiting scholar’s primary research activity will be teaching. The maximum time allowed in the U.S. on this visa is five years. 3. Short Term Scholar: The visiting scholar’s primary activity will be lecturing, consulting, or attending seminar/conference/study tours. The maximum time allowed in the U.S. on this visa is six months. No extensions are allowed. 4. Student Intern: The visiting scholar is a student in another country who will be doing research at UA Little Rock as part of his/her degree requirements. The maximum amount of time allowed in the U.S. on this visa is 12 months. I acknowledge that the J-1 visa program cannot be used for tenure-track or tenured faculty appointments.(Required) I understand.Has the visiting scholar obtained a U.S. Visa?(Required) Yes No If yes, what type?(Required)Has the visiting scholar visited the United States in the past two years?(Required) Yes No If yes, what best describes his/her visit? Vacation Research Attended School Academic Appointment Business Verification of Past U.S. Visits(Required)I will have a conversation with the visiting scholar about the purpose, dates, and visa type for their previous visit to the U.S. if they have visited the U.S. before. I agree. Has the visiting scholar ever been a citizen or legal resident of a country besides their native country?(Required) Yes No Is the visiting scholar's passport or permanent residency document currently invalid?(Required) Yes No If yes, provide details:(Required)What are the visiting scholar's plans after returning to his/her native country?(Required)Has the visiting scholar applied for U.S. citizenship or permanent U.S. residency:(Required) Yes No If yes, provide details:(Required)Does the visiting scholar have any previous or current foreign military service?(Required) Yes No Has the visiting scholar been involved in any past or current foreign talents programs?(Required) Yes No If yes, please explain:(Required)English Language Proficiency VerificationI have determined that the visiting scholar has sufficient English proficiency to participate in this program.(Required) Yes How have you verified the visiting scholar’s English language proficiency?(Required) TOEFL or IELTS scores The visiting scholar has attended a U.S. school for at least two years Interview with at least two UA Little Rock faculty members See the English Language Proficiency Assessment Form.Financial Support Information and DocumentationNote: the following document(s) must be in English. Please verify this before submitting. All documents must be dated within the last six months.How will the visiting scholar be supporting him/herself and any dependents?(Required) UA Little Rock funding (see below) Funding from the visiting scholar’s government Visiting scholar’s personal funds Fulbright Scholarship Other organization(s) Does the department receive funding for international exchange from one or more U.S. Government Agency(ies) that will be used to support this exchange visitor?(Required) Yes No Indicate all U.S. Government Agencies that will be providing international exchange funding for the scholar:(Required) Action (Includes Peace Corps and VISTA) Agency for International Development Broadcasting Board of Governors Department of Agriculture Department of Commerce Department of Defense Department of Education Department of Energy Department of Health and Human Services Department of Housing and Urban Development Department of Justice Department of Labor Department of State Department of the Interior Department of the Treasury Department of Transportation Environmental Protection Agency Export-Import Bank of the United States General Accounting Office Holocaust Memorial Council Library of Congress National Aeronautics and Space Administration (NASA) National Endowment for the Arts National Endowment for the Humanities National Science Foundation Smithsonian Institution U.S. Institute of Peace Veterans Administration Other If other, please provide a funding agency.I have verified the visiting scholar’s funding information, and it meets UA Little Rock's minimum monthly amount required.(Required) I agree. Financial Support Documentation(Required) Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 1 MB. Health Insurance VerificationWill the visiting scholar be enrolling in UA Little Rock health insurance?(Required) Yes No, the visiting scholar will be enrolling in private coverage. The visiting scholar will decide at orientation. Statement of Compliance with Exchange Visitor Health Insurance Requirements (Submit Statement of Compliance with Exchange Visitor Health Insurance Requirements Form)(Required) Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 1 MB. Scope of Work InformationDates of Proposed Activity.From(Required) MM slash DD slash YYYY To(Required) MM slash DD slash YYYY How many hours per week will the visiting scholar work or volunteer on the proposed activity?(Required)Location (building and room) where visiting scholar will conduct research:(Required)Does the proposed work to be done, equipment to be used, and research materials used meet the definition of Fundamental Research Exclusion and are not export controlled?(Required) Yes No Provide a detailed description of the activities/scope of work in which the visiting scholar or volunteer will engage for the duration of the program or for the host faculty member. Include any projects that the visiting scholar will be working on.(Required)To comply with federal export control requirements, what specialized laboratory equipment, materials, instruments, software, or machinery will the visiting scholar use while at UA Little Rock while working on your projects? (Please list)(Required)Is the proposed activity associated with an externally funded program?(Required) Yes No If yes:a. Source of external funding, title of funded program, award number, and date of award: b. Description of the funded program: What are the expected outcomes of the visit?(Required) Will the visiting scholar be involved in any export control issues?(Required) Yes No If yes, please explain.Explain how the hosting faculty member will monitor the progress and welfare of the visitor to ensure that the visiting scholar obtains sufficient guidance to fulfill the objectives of the program.(Required)Hosting Faculty Member AttestationsThe hosting UA Little Rock faculty member must complete the following section. These attestations are required and are considered binding by UA Little Rock. I have completed the CITI Training on Export Control and the Responsible Conduct of Research CITI training.(Required) Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 1 MB. I have a working knowledge of federal, state, and university policies that govern the terms of a visiting scholar.(Required) Yes I will ensure that the visiting scholar completes Export Control and the Responsible Conduct of Research CITI training prior to engaging in UA Little Rock research.(Required) Yes Please send their certificates to the Export Control Officer at [email protected] upon completion.I will ensure there is no conflict of interest in collaborating with the visiting scholar.(Required) Yes I have informed the visiting scholar in writing that UA Little Rock faculty have first rights of publication of any discovery, data, or other research‐related findings.(Required) Yes I have informed the visiting scholar that UA Little Rock is not obligated to provide compensation or extensions to visits beyond the terms of the agreement.(Required) Yes I understand that the department will not agree to pay any fees without the express written approval of the sponsoring dean.(Required) I understand. No fees will be charged by the hosting faculty or department to the scholar.(Required) I agree. I have determined that the visitor has the appropriate education and experience to perform and participate in the proposed activity.(Required) Yes I will ensure that the availability of office space, non-export controlled equipment, materials and/or supplies, and other necessary support will be available to the scholar for the duration of his/her program at UA Little Rock.(Required) I agree. I will be physically present for the duration of the scholar’s activity at UA Little Rock except for short reasonable absences of time during which my on campus designee will be responsible.(Required) Yes I will monitor the visitor’s progress to ensure successful completion for the program objective.(Required) Yes I understand that as the sponsor of the visiting scholar, I am responsible for that individual’s conduct while on campus.(Required) I understand. The visiting scholar has been provided a copy of standard operating procedures for UA Little Rock laboratories and a copy of UA Little Rock policies.(Required) Yes Not yet, but they will. I certify that I understand all hiring rules of UA Little Rock and will comply fully with them.(Required) Yes I certify that the information provided on this application is true and accurate.(Required) Yes Captcha
