Resources > Title 22 CFR Part 62 (Exchange Visitors)

Appendix

Last modified on Apr 09, 2023

62a Certification of Responsible Officers and Sponsors

In accordance with the requirement at § 514.5(c)(6), the text of the certifications shall read as follows:

1. Responsible Officers and Alternate Responsible Officers

I hereby certify that I am the responsible officer (or alternate responsible officer, specify) for exchange visitor program number ____, and that I am a United States citizen or permanent resident. I understand that the Department of State may request supporting documentation as to my citizenship or permanent residence at any time and that I must supply such documentation when and as requested. (Name of organization) agrees that my inability to substantiate the representation of citizenship or permanent residence made in this certification will result in the immediate withdrawal of its designation and the immediate return of or accounting for all Forms IAP-66 transferred to it.

Signed in ink by
(Name)
(Title)
Witness:

This ______ day of ______, 19__. Subscribed and sworn to before me this ______ day of ______, 19__.

Notary Public

2. Sponsors.

I hereby certify that I am the chief executive officer of (Name of Organization) with the title of (specify); that I am authorized to sign this certification and bind (Name of Organization). I further certify that (Name of Organization) is a citizen of the United States as that term is defined at 22 CFR § 514.2. (Name of Organization) agrees that inability to substantiate the representation of citizenship made in this certification will result in the immediate withdrawal of its designation and the immediate return of or accounting for all Forms IAP-66 transferred to it.

Signed in ink by
(Name)
(Title)
Attestation/Witness:

This ______ day of ______, 19__. Subscribed and sworn to before me this ______ day of ______, 19__.

Notary Public

62b Exchange Visitor Program Services, Exchange-Visitor Program Application

62b Form title

Form Approved OMB Serial No.

1. Name and Address of Sponsoring Organization

2. Name and Title of Responsible Officer
Telephone Number

3. Name and Title of Alternate Responsible Officer
Telephone Number

4. Type of Application
(check one)
New ___ Re-Apply ___
Re-Designation

62b Sections 1-3

Section I—Program Participant Data (For Definition & Length of Stay See 22 CFR ___)

5. Participation by Category (indicate total no. and approximate duration of stay in each category)

A. Student
B. Teacher
C. Professor
D. Researcher
E. Short-term Scholar
F. Specialist
G. Trainee
1. Specialty
2. Nonspecialty
H. Int'l Visitor
I. Gov't Visitor
J. Physicians
K. Camp Cnslr
L. Sumr/Wk/Trvl
6. Method Of Selection
7. Arrangements for Financial Support of Exchange Visitor while in the U.S.

Section II—Program Data

8. Outline of Proposed Activities (If training, See Reverse)
9. Arrangements for Supervision and Direction
10. Purpose of Objective
11. Role of other Organizations Associated with Program (if any)

Section III—Certification

12. Citizenship Certification of Organization and Responsible Officer (see reverse)
13. I certify that information given in this application is true to the best of my knowledge and belief and that I have completed appropriate information on reverse of this form.
Signature of Responsible Officer
Date

Tab 3 62b Instructions, reapplication, certification

Instructions for All Programs

If additional space is needed in supplying answers to any questions, please use continuation sheets on plain white paper.
1-3. Names and addresses of organization and telephone numbers.
4. Select type of application.
5. Select appropriate categories (see 22 CFR prior to filling out this data).
6-7. Complete information on program sponsor.
8-11. Complete information on program.

IF TRAINING PROGRAM, identify appropriate fields: 01—Arts & Culture; 02—Information Media and Communications; 03—Education; 04—Business and Commercial; 05—Banking and Financial; 06—Aviation; 07—Science, Mechanical and Industrial; 08—Construction and Building Trades; 09—Agricultural; 10—Public Administration; 11—Training, Other

Reapplication and Redesignation:

If your organization is making reapplication as an exchange visitor program, or applying for redesignation under 22 CFR __, please certify to the following:

I hereby certify that as an officer of the organization making application for an exchange program under 22 CFR __ or 22 CFR __ that the following documents which have been submitted to the Department of State, Exchange Visitor Program Services, remain in effect and not altered in any way:

(1) Legal status as a corporation such as Articles of Incorporation and By Laws. Provide dates and state of both:____

(2) Accreditation. Provide date, type of accreditation, and State of accreditation:___

(3) Evidence of Licensure. Provide date, type of license, and state of licensure:___.

(4) Authorization of governing body authorizing application. Please provide date of such authorization and authorizing body:______.

(5) Activities in which the organization has been engaged have not changed since application dated:___.

(6) Citizenship. Provide the date of compliance with citizenship requirements:____. If citizenship compliance is not current, please complete the following:
Organization: I hereby certify that I am an officer of ____ with the title of ____; that I am authorized by the (Board of Directors, Trustees, etc.) to sign this certification and bind ___; and that a true copy certified by the (Board of Directors, Trustees, etc.) of such authorization is attached. I further certify that ___ is a citizen of the United States as that term is defined at 22 CFR 514.1.

Responsible Officer or Alternate Responsible Officer: I hereby certify that I am the responsible officer (or alternate responsible officer) for ___, and that I am a citizen of the United States (or a person lawfully admitted to the United States for permanent residence. ____ agrees that my inability to substantiate my citizenship or status as a permanent resident will result in the immediate withdrawal of its designation and immediate return of or accounting for all IAP-66 forms transferred to it.

Certification as to (1)-(6) Requirements:

I understand that false certification may subject me to criminal prosecution under 18 U.S.C. 1001, which reads: “Whoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies, conceals or covers up by any trick, scheme or device a material fact or makes any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than five years, or both.”

Signed in ink by (Name)
Title
Subscribed and sworn to before me this _______ day of _______, 19__. Notary Public

Department of State Use Only

Type of program:
Subtype if applicable:
No. Forms IAP-66:
Categories:

Please return form to:

Exchange Visitor Program Services-GC/V, Department of State, Washington, DC 20547

Note:

Public reporting burden for this collection of information (Paperwork Reduction Project: OMB No. 3116-0011) is estimated to average __ minutes/hours per response, including time for reviewing instructions, researching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of State Clearance Officer, M/ASP, Department of State, 301 4th Street, SW., Washington, DC 20547; and to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.

62c Update of Information on Exchange-Visitor Program Sponsor

Please amend the Department of State records for Exchange-Visitor

Program Number
assigned to ________ as follows:
(Name of institution/organization)

1. Change the name of the Program Sponsor
from the above to

2. Change the address of the Program Sponsor
From:
(city)(state)(zip)
To:
(city)(state)(zip)

3. () Change the telephone number from ____ to ____
() Change the fax number from ____ to ____

4. () Change the name of the Responsible Officer of the above program from ____ to ____

5. a. Delete the following Alternate Responsible Officer:

5. b. Add the following Alternate Responsible Officer:

(Citizenship is required for all Responsible and Alternate Responsible Officers-See Reverse)

6. () Send ___ (indicate number) IAP-66 forms. (PLEASE ALLOW FOUR TO SIX WEEKS FOR RESPONSE AND REMEMBER TO SUBMIT THE ANNUAL REPORT)

7. () Send ___ copies of this form.

8. () Send ___ copies of Codes for Educational and Cultural Exchange.

9. ( ) Cancel the above named Exchange Visitor Program.
(Signature of Responsible or Alternate Responsible Officer)
(Date)
(Title of Signing Officer)

62d Annual Report—Exchange Visitor Program Services (GC/V)

Exchange Visitor Program No. ___ Reporting Period ___ Provide Range of Forms IAP-66 Documents Covered by this Report (___-___).

(A) STATISTICAL REPORT

(1) ACTIVITY BY CATEGORY
Professor ....................................... _
Research Scholar .......................... _
Short-term Scholar ...................... _
Trainee ......................................... _
Student (College and University) _
Student (Practical Trainee) .......... _
Teacher ......................................... _
Student (Secondary) ..................... _
Specialists .................................... _
Physicians .................................... _
International Visitors ................... _
Government Visitors .................... _
Camp Counselors ........................... _
Total ....................................... _

(2) Forms IAP–66 Reconciliation
(i) Number of Forms IAP–66 voided or otherwise not used by participant _.
(ii) Number of Forms IAP–66
issued for dependents _.
(iii) Number of Forms IAP–66 currently on hand _.

(b) PROGRAM EVALUATION

On a separate sheet, please provide a brief narrative report on program activity, difficulties encountered and their resolution, program transfers, anticipated growth and the proposed new activity, cross-cultural activities, as well as the reciprocal component of the program.

I, The Responsible Officer of the program indicated above, certify that we have complied with the insurance requirement (22 CFR 514.14). I also certify that the information contained in this report is complete and correct to the best of my knowledge and belief.

Responsible Officer (signed) ________
Date _______
Name and address of sponsoring institution ________

62e Unskilled Occupations

For purposes of 22 CFR 514.22(c)(1), the following are considered to be “unskilled occupations”:

(1) Assemblers
(2) Attendants, Parking Lot
(3) Attendants (Service Workers such as Personal Services Attendants, Amusement and Recreation Service Attendants)
(4) Automobile Service Station Attendants
(5) Bartenders
(6) Bookkeepers
(7) Caretakers
(8) Cashiers
(9) Charworkers and Cleaners
(10) Chauffeurs and Taxicab Drivers
(11) Cleaners, Hotel and Motel
(12) Clerks, General
(13) Clerks, Hotel
(14) Clerks and Checkers, Grocery Stores
(15) Clerk Typist
(16) Cooks, Short Order
(17) Counter and Fountain Workers
(18) Dining Room Attendants
(19) Electric Truck Operators
(20) Elevator Operators
(21) Floorworkers
(22) Groundskeepers
(23) Guards
(24) Helpers, any industry
(25) Hotel Cleaners
(26) Household Domestic Service Workers
(27) Housekeepers
(28) Janitors
(29) Key Punch Operators
(30) Kitchen Workers
(31) Laborers, Common
(32) Laborers, Farm
(33) Laborers, Mine
(34) Loopers and Toppers
(35) Material Handlers
(36) Nurses' Aides and Orderlies
(37) Packers, Markers, Bottlers and Related
(38) Porters
(39) Receptionists
(40) Sailors and Deck Hands
(41) Sales Clerks, General
(42) Sewing Machine Operators and Handstitchers
(43) Stock Room and Warehouse Workers
(44) Streetcar and Bus Conductors
(45) Telephone Operators
(46) Truck Drivers and Tractor Drivers
(47) Typist, Lesser Skilled
(48) Ushers, Recreation and Amusement
(49) Yard Workers

62f Information To Be Collected on Secondary School Student Host Family Applications

62f Basic Family Information

a. Host Family Member—Full name and relationship (children and adults) either living full-time or part-time in the home or who frequently stay at the home)

b. Date of Birth (DOB) of all family members

c. Street Address

d. Contact information (telephone; e-mail address) of host parents

e. Employment—employer name, job title, and point of contact for each working resident of the home

f. Is the residence the site of a functioning business? (e.g., daycare, farm)

g. Description of each household member (e.g., level of education, profession, interests, community involvement, and relevant behavioral or other characteristics of such household members that could affect the successful integration of the exchange visitor into the household)

h. Has any member of your household ever been charged with any crime?

Tab 2 62f Household Pets

a. Number of Pets
b. Type of Pets

Tab 3 62f Financial Resources

a. Average Annual Income Range: Less than $25,000; $25,000-$35,000; $35,000-$45,000; $45,000-$55,000; $55,000-$65,000; $65,000-$75,000; and $75,000 and above. Note: The form must include a statement stating that: “The income data collected will be used solely for the purposes of ensuring that the basic needs of the exchange students can be met, including three quality meals and transportation to and from school activities”

b. Describe if anyone residing in the home receives any kind of public assistance (financial needs-based government subsidies for food or housing)

c. Identify those personal expenses expected to be covered by the student

Tab 4 62f Diet

a. Does anyone in the family follow any dietary restrictions? (Y/N)
If yes, describe:

b. Do you expect the student to follow any dietary restrictions? (Y/N)
If yes, describe:

c. Would you feel comfortable hosting a student who follows a particular dietary restriction (ex. Vegetarian, Vegan, etc.)? (Y/N)

d. Would the family provide three (3) square meals daily?

Tab 5 62f High School Information

a. Name and address of school (private or public school)

b. Name, address, e-mail and telephone number of school official

c. Approximate size of the school student body

d. Approximate distance between the school and your home

e. Approximate start date of the school year

f. How will the exchange student get to the school (e.g. bus, carpool, walk)?

g. Would the family provide special transportation for extracurricular activities after school or in the evenings, if required?

h. Which, if any, of your family's children, presently attend the school in which the exchange visitor is enrolled?
If applicable list sports/clubs/activities, if any, your child(ren) participate(s) in at the school

i. Does any member of your household work for the high school in a coaching/teaching/or administrative capacity?

j. Has any member of your household had contact with a coach regarding the hosting of an exchange student with particular athletic ability?
If yes, please describe the contact and sport.

Tab 6 62f Community Information

a. In what type of community do you live (e.g.: Urban, Suburban, Rural, Farm)

b. Population of community

c. Nearest Major City (Distance and population)

d. Nearest Airport (Distance)

e. City or town website

f. Briefly describe your neighborhood and community

g. What points of interest are near your area (parks, museums, historical sites)?

h. Areas in or near neighborhood to be avoided?

Tab 7 62f Home Description

a. Describe your type of home (e.g., single family home, condominium, duplex, apartment, mobile home) and include photographs of the host family home's exterior and grounds, kitchen, student's bedroom, student's bathroom, and family and living areas.

b. Describe Primary Rooms and Bedrooms

c. Number of Bathrooms

d. Will the exchange student share a bedroom? (Y/N)
If yes, with which household resident?

e. Describe the student's bedroom

f. Describe amenities to which the student has access

g. Utilities

Tab 8 62f Family Activities

a. Language spoken in home

b. Please describe activities and/or sports each family member participates in: (e.g., camping, hiking, dance, crafts, debate, drama, art, music, reading, soccer, baseball, horseback riding)

c. Describe your expectations regarding the responsibilities and behavior of the student while in your home (e.g., homework, household chores, curfew (school night and weekend), access to refrigerator and food, drinking of alcoholic beverages, driving, smoking, computer/Internet/E-Mail)

Would you be willing voluntarily to inform the exchange visitor in advance of any religious affiliations of household members? (Y/N)

Would any member of the household have difficulty hosting a student whose religious beliefs were different from their own? (Y/N) Note: A host family may want the exchange visitor to attend one or more religious services or programs with
the family. The exchange visitor cannot be required to do so, but may decide to experience this facet of U.S. culture at his or her discretion.

How did you learn about being a host family?