COMMISSION ON FILIPINOS OVERSEAS
PHOTO
INFORMATION SHEET FOR EVP PARTICIPANTS (J1 Visa Holders)
INSTRUCTIONS : Please PRINT letters in the spaces provided.
(FOR CFO USE ONLY)
CFO No. / EVP No.
Reg. Date [ mm-dd-yy ]
OR #
Verifier
NEW REGISTRATION
REVALIDATION
PERSONAL DATA
Last Name
Suffix
First Name
Middle Name
If married, please state mother's maiden name
AGE
DATE OF BIRTH [ mm-dd-yyyy ]
SEX
Single
Widow(er)
CIVIL STATUS
Divorced
Male Female
Married
Separated
Outside of the Philippines
PLACE OF BIRTH
Town / City
Province
ADDRESS & CONTACT NUMBERS IN THE PHILIPPINES
House No. / Street / Barangay
Town / City
Province
Zip Code
Telephone Number
Email Address
Cellphone Number
ADDRESS & CONTACT NUMBERS IN THE UNITED STATES
House No. / Street
Zip Code
City / State
Telephone Number
Email Address
Cellphone Number
PASSPORT NUMBER
DATE OF ISSUE [ mm-dd-yyyy ]
VISA NUMBER
DATE OF ISSUE [ mm-dd-yyyy ]
If vocational / college / post graduate
HIGHEST EDUCATIONAL ATTAINMENT
High School Level
High School Graduate
Vocational Level
Vocational Graduate
College Level
College Graduate
Post Graduate Level
Post Graduate
Employed
ECONOMIC STATUS
School Name and Course
Address
Self-employed
Unemployed
If employed/self-employed, state profession/occupation/business/employer in the past six(6) months
If unemployed, check appropriate box
Housewife
Student
Retiree
Out-of-school youth
Not reporting any occupation
DEPENDENT(S) WHO WILL ACCOMPANY YOU DURING YOUR TRAINING IN THE UNITED STATES (J-2 visa holders)
NAME
Revised as of December 2013
RELATIONSHIP
DATE OF BIRTH [ mm-dd-yyyy ]
THIS FORM IS NOT FOR SALE
CATEGORY OF EVP PARTICIPANT
Alien Physician
Au Pair
Camp Counselor
Government Visitor
DURATION OF YOUR TRAINING
International Visitor
Research Scholar
Secondary School Student
Short-term Scholar
Trainee/Intern
Specialist
Student
Summer Work/Travel
Teacher
From [ mm-dd-yyyy ]
To
[ mm-dd-yyyy ]
FIELD OF SPECIALIZATION IN THE UNITED STATES
INFORMATION ABOUT THE SPONSORING / HOST INSTITUTION IN THE UNITED STATES
Name of Sponsoring Institution
Name of Responsible / Alternate Officer of Sponsoring Institution
Designation/Title of RO or ARO
Address
Telephone Number
Cellphone Number
E-mail Address
Host/Training Institution (If different from sponsoring institution)
Address
Telephone Number
Cellphone Number
E-mail Address
INFORMATION ABOUT THE LOCAL AGENCY IN THE PHILIPPINES
Name of Local Agency
Address
Telephone No.
Cellphone No.
Email Address
DATA OF NEAREST FAMILY MEMBER LEFT IN THE PHILIPPINES
Name
Relationship
Address
E-mail Address
Telephone Number
Cellphone Number
FUNDING SOURCE
If funded by the Philippine and/or U.S. Government or a private
Philippine Government
Private company / organization
U.S. Government
Personal
organization / company, please state name of agency
I understand that the following conditions are applicable to all Exchange Visitors:
TWO-YEAR HOME-COUNTRY PHYSICAL PRESENCE REQUIREMENT (Section 212 (E) of the U.S. Immigration and Nationality
Act and PL94-484, as amended): Exchange Visitors and their dependents are subject to the 2-year Home-Country Physical Presence
Requirement. All EVP participants whose programs are financed in whole or in part, directly or indirectly by either the Philippine or U.S.
Government, are required to reside in their home country for two-years following the completion of their program before they are eligible for
Immigrant Status, Temporary Worker (H) Status, or Intracompany Transferee (L) Status. Likewise, all EVP participants whose field of
specialization is included in the E.V.P. Skills List are subject to the same requirement. All E.V.P. participants in the field of Medicine
are covered by said requirement.
LIMITATION OF STAY:
Students - those who are pursuing a full course of study towards a degree, or engaged full-time in a non-degree program up to 24
months. Students for whom the sponsor recommends academic training may be allowed to remain for an addtional period of up to 18
months after receiving their degree or certificate; post-doctoral academic training of up to 36 months; secondary students up to 1 academic
year. Trainees-18 months; flight trainess-24 months; teachers, professors and research scholars-3 years; short-term scholars-6
months; specialist-a year; physicians-the time typically required to complete the medical specialty involved but limited to 7 years with the
possibility of extension if approved by the Director of the U.S. Information Agency; government visitor-up to 18 months; camp
counselor-up to 4 months; summer work/travel-up to 4 months.
CERTIFICATION
I have read and understood the foregoing, including the Two-year Home-Country Physical Presence Requirement, and
agree to comply with the Exchange Visitor Program Regulations, as amended (22 CFR Part 514).
I understand that it is my responsibility to maintain my Exchange Visitor Status.
I certify that all the information on this form is true and correct to the best of my knowledge.
SIGNATURE ABOVE PRINTED NAME
Revised as of December 2013
