International College Program Fall 20___  Spring 20___
Applicant Information: Please print your name as it appears on your passport in all capital letters.

Family/Last Name:FirstMiddle Name:

Telephone: ___________________________

Gender: Male Female

Date of Birth (MM/DD/YYYY):Country of Birth:City of Birth:

Country of Citizenship:

Email Address:

Foreign Address

U.S. Address (if available):

Address Line 1:

Address Line 1: _______________________________

Address Line 2:

Address Line 2: _Address Line 3:

Address Line 3:

City:

City:

_____________________________

State/Province:

State/Province________________________________

Postal Code:

Zip Code:______________________________Country:______________________________Country:_____________________________________

Educational Information:
Graduated from High School? Yes No

Date of High School Graduation ___________Have you ever attended Valencia? Yes No

Dates attended: from ______________to ______________

Current University/College/Institute _____________________________________________________________________________
Career/major course of study_________________________

Dates attended: from ______________ to ______________

Emergency Contact::
Name: __________________________________________

Relationship: ____________________________________

Phone (including country and city code): ______________________________________________________________________
Email Address: __________________________________________________________________________________________
I certify that all information on this application is true. I agree to abide by all Valencia College rules and regulations. I agree to pay Valencia’s tuition
and fees and any reasonable collection costs if applicable.
Student Signature: ___________________________________________________________________

1Date _________________

International College Program
Please print and fill in the first section of this form. This form is to be filled out by a professor or school official who is able
to comment on your academic standing and program of study.
Part 1: To be completed by student.

Date (mm/dd/yyyy): ___________

Student’s Name: ________________________

Current Institution: _________________________

Major: _________________________________

Date of Degree Completion: __________________(mm/dd/yyyy)

Are you a full-time student? □ Yes□ NoPart 2: To be complete by professor or school official. Please share any additional information about the student (if applicable).
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________As a representative of the above institution, I attest that the student mentioned on this form is in good academic standing
and their course of study directly relates to Valencia’s J Exchange Visitor Program titled “Valencia’s International College
Program with Academic Training at the Walt Disney World Resort.”

School Official’s Name : ______________________ School Official’s Title/Department: ______________________
Official’s Phone Number: ______________________ Official’s Email: _____________________________________

School Official’s Signature: _____________________________

Date (mm/dd/yyyy):_____________________

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International College Program
Below please write a short paragraph explaining why you want to participate in Valencia’s Exchange Visitor Program and how it relates to your course of study. Please print clearly.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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International College ProgramThis confidential financial certification form MUST be completed before the DS-2019 will be issued. Supporting financial
documents can be no more than 30 days old from the date of application or reapplication. If you have any questions aboutcompleting this form, please see your school contact.

Application fee

Fees
$50

Tuition fee (full-time enrollment—12 credit hours)$2450

Accident and Sickness Insurance, 6 months (mandatory)*$690*Subject to change
Living expenses for 2 weeks before first WDW pay (food, transportation, etc.)$400

Total Financial Requirement$3,590Financial Support in U.S. Dollars:
NOTE: No investment or credit card accounts will be considered.
1. Personal Checking and/or Savings Amount :$ ______________________

2. Sponsor(s) Funds Amount:
Print Sponsor(s) Name: ______________________________________$ ______________________

Sponsor(s) Address:____________________________________________________________________________

3. J-1 Student’s Government/Other Organizational Sponsorship Funds Amount:
Print Name of Agency:$ ____________________________________________________________TOTAL:$_______________________

AFFIDAVIT OF FINANCIAL SUPPORTThe affidavit below must be completed by the family member or sponsor and must match the name of the account holder provid- ed in the bankletter or statement. Students do not need to complete this section if all financial support comes from personal funds.
Subject: Funding for _________________________________(Name of Student)
Please note that I, ________________________________do hereby affirm that I will provide financial support for the participant(Sponsor Name)listed above from _______________________ through _________________________ in the amount of ___________________ .
(Program Start Date)(Program End Date)(U.S. Dollars)

These funds will pay for the fees described in the Certification of Finances Form. Enclosed is a bank letter or bank statement from my financial
institution.
Signature of Sponsor:

Date Signed:

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International College Program

J Exchange Visitor Responsibility Form

All exchange visitors are responsible for learning, understanding, and complying with United States federal laws and regulations
governing the J visa. Failure to do so will violate the exchange visitor’s legal status in the U.S. Please read the information below.
Then sign and date the form and submit it with your registration packet.
As an Exchange Visitor, my responsibilities include but may not be limited to the following items listed below:

Upon arrival to the United States, check in with the RO/ARO and get registered in SEVIS.

Retain required documentation at all times which include a valid DS-2019, I-94 card, and valid passport during the entire length of the program.

Engage only in appropriate activities permitted, specifically in Section 4 of the DS-2019.

Report address changes to your assigned RO/ARO within ten (10) days of the move date.

Maintain the required sickness and injury insurance coverage for the entire program period.

Comply with employment guidelines and refrain from any unauthorized employment. All employment activity that is not included in Part 4 on the DS2019 must be approved in writing by the RO/ARO before the activity begins. Students may only work at the designated internship site and be “in goodstanding” with their employer.

Report any proposed program changes to the RO/ARO in advance.

Obtain a travel signature on the DS-2019 from the RO/ARO prior to departing the United States anytime during your program duration. Please notethat exchange visitors may not be allowed to re-enter the U.S. without travel authorization.

Comply with all academic program guidelines and acceptable standards of conduct.

As email is the primary means of communication with Valencia, I agree to check my email on a regular basis while in this program.

Report my departure date and reason to the RO/ARO in advance. I must depart the United States within 30 days of completing or ceasing program
activities. Overstaying the 30 days is a serious immigration violation that may negatively affect my ability to obtain a new visa or re-enter the U.S. inthe future.

Home-Country Physical Presence Requirement: This requirement means that an Exchange Visitor who is within the purview of section 212(e) ofthe Immigration and Nationality Act (substantially quoted in §62.44) must reside and be physically present in the country of nationality or last legal
permanent residence for an aggregate of at least two years following departure from the United States before the exchange visitor is eligible to applyfor an immigrant visa or permanent residence, a nonimmigrant H visa as a temporary worker or trainee, a nonimmigrant L visa as an intra-company
transferee, or a nonimmigrant H or L visa as the spouse or minor child of a person who is a temporary worker or trainee or an intra-company transferee.

Cancellation Policy: There are NO refunds after the start of the program unless there is a family or national emergency. In that case, a prorated
refund on tuition may apply. If your visa is denied by the U.S. Department of State, the $50 application fee is nonrefundable.

I have read and understood my responsibilities as an Exchange Visitor at Valencia College. I understand that failure to comply with the above requirements
will result in the termination of my DS-2019, my program at Valencia College, and all employment contracts. I also understand a termination of my DS-2019 may
negatively affect my ability to obtain a new visa in the future.
I have read and agree to comply with the terms and conditions of my admission and those of any extensions of stay as specified by federal regulations. I
certify that all information provided on these forms refers specifically to me and is true and correct to the best of my knowledge. I certify that I seek to enter orremain in the United States temporarily, at Valencia College, solely for the purpose of pursuing the activity or activities identified in item 4 of the DS-2019.

___________________________________
Exchange Visitor’s Name (Print)____________________________________
Signature

5__________________
Date