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Host Eligibility & Verification Form

The ${'ev19_name_'.$ev19_id} supports FUSIA’s vetting process — confirming that reported information is accurate, the business is active and legitimate, and host eligibility requirements are met.

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Part 1 Declarations

The undersigned parties listed below, representing (Host or ), as a host (or intended host) of FUSIA-sponsored EV(s), hereby:

1 Acknowledge that hosting FUSIA-sponsored EV(s) requires participation in EVP of DOS, and affirm that and all assigned staff involved with FUSIA’s EVP program shall comply with all applicable US law, 22 CFR Part 62, DOS guidance and updates, and sponsor-imposed terms, and shall cooperate fully with FUSIA in the discharge of its oversight responsibilities.

2 Confirm that all individuals designated by to serve as the Main Program Supervisor (MPS/POC) or Primary Phase Supervisor (PPS) are duly authorized to represent , make program-related decisions, and execute all related documentation — In the event that a designated MPS and/or PPS is no longer serving in their role or becomes unavailable, all previously executed program documentation shall remain binding until a successor is designated and signs again.

4 Confirm that all information submitted by , as stated in , , and , is true, complete, current, and accurate to the best of its knowledge — In the event of any change to submitted information, shall notify and obtain authorization for the change from FUSIA in advance (or immediately, if unforeseen), and, upon approval, complete the necessary amendment tasks within 72 hours unless otherwise permitted.

5 Confirm that all supporting materials provided by are valid, authentic, and current — Any documentation with an expiration date must be resubmitted prior to its expiration to prevent any lapse in program compliance.

6 Confirm that meets all host eligibility requirements as set forth in this document — In the event of any actual or potential change in circumstances affecting continued eligibility, shall immediately notify FUSIA.

7 Acknowledge that information provided by will be entered into SEVIS (a database for F/M/J visa holders) and may be disclosed to involved US government agencies, -hosted EV(s), FUSIA staff, and third parties (e.g., partner schools) involved in program administration.

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Supervisor(s):
Signature Date: 05-09-2025 EST EST | ☐ New Host / New Form | ☐ Existing Host / Updated Form

INDEX:

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Part 3 Host Eligibility

Review the eligibility criteria below and sign this document to confirm that meets all of them.

General

Per 22 CFR § 62.22(g), EVP sponsors are responsible for thoroughly screening host organizations and ensuring full compliance.

1 Operate as a US entity with a valid EIN (Employer Identification Number) and at least one year of operation – 62.22(g)(3)(i)
2 Cooperate with FUSIA to conduct necessary vetting by providing required records timely – 62.22(g)(3)(ii)
3 Maintain valid Worker’s Compensation or equivalent coverage for EVs, unless exempt under state law – 62.22(g)(3)(iii)
4 Conduct a documented interview with the EV and issue an offer letter with relevant details – 62.22(f)(3)
5 Have sufficient resources, facilities, equipment, and trained onsite staff to conduct the training – 62.22(f)(2)(i)
6 Is not a staffing/employment agency and does not use any such agency for any part of the program – 62.22(j)(3)
7 Has no pending labor/health/safety/tax investigations, litigation, or controversies, and no violation of US law – 62.13(d)
8 Does not engage EVs or involve the program in any way that could bring FUSIA, EVP, or DOS into disrepute – 62.22(j)(2)
9 Is not owned, controlled by, or affiliated with any foreign government or organization, nor includes any owner or staff involved in the program with ties to entities subject to US sanctions, export restrictions, or security advisories, or otherwise deemed by FUSIA to pose risks to EVP integrity, sensitive technologies, or US interests – 62.10

Site of Activity

Each EV and training program is anchored to at least one pre-approved Site of Activity with sufficient resources, facilities, equipment, and personnel, per 22 CFR § 62.22(f)(2)(i). Hosts with fewer than 25 employees or under $3 million in revenue require a site visit unless exempt. If multiple sites are involved, each requires a separate screening and DS-7002.

1 Allow FUSIA site visit if there are fewer than 25 full-time staff or under $3M in annual revenue, unless exempt – 62.22(g)(4)
2 Have sufficient resources, plant, equipment, and trained personnel to implement FUSIA-sponsored programs – 62.22(f)(2)(i)
3 Located within 25 miles of EV housing, in a safe, accessible area near affordable housing and basic services – 62.22(f)(2)(i)
4 No requirement for EV to bring or use personal items/equipment (e.g., laptop) to perform the role, unless voluntarily chosen
5 No work-related expenses imposed on EV unless agreed in advance and reimbursed within one week
6 No remote or hybrid work arrangements allowed — onsite participation is required under EVP
7 No setting that poses risks to EV’s well-being, contradicts EVP objectives, or is deemed an unconducive professional environment by FUSIA (e.g., no home office, gaming, warehouse, fulfillment, or retail) – 62.22(f)(2)(i), (j)

Supervision

Each EV and training program has one Main Program Supervisor (MPS/POC) who manages administrative matters and liaises with FUSIA and involved supervisor(s), and one Primary Phase Supervisor (PPS) who provides continuous, day-to-day technical guidance and onsite supervision as per 22 CFR § 62.22(f)(2)(i–ii).

1 Ensure all involved staff are knowledgeable, experienced, trained, qualified, and clear on program rules and updates
2 Assign 1+ staff for MPS and PPS roles, plus supporting supervisor(s) as needed, to ensure “continuous onsite supervision”
3 MPS and PPS hold a postsecondary degree/certificate (or higher) or have 1+ year (MPS) / 2+ years (PPS) of experience
4 MPS may serve as PPS if qualified; each PPS may supervise up to 3 EVs concurrently unless otherwise permitted by FUSIA
5 PPS must be full-time, onsite, and possess relevant experience and subject-matter expertise
6 MPS and PPS must be W-2 employees of the Host, accessible by mobile in emergencies, authorized to execute program documents, use a company-domain email for correspondence, and able to allocate sufficient time to comply with the program’s administrative and monitoring requirements with timely turnaround

Host Eligibility & Verification Form

Part 1 Declarations

Part 2 Host Profile

Part 3 Host Eligibility