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As part of the English proficiency screening process to confirm that the applicant for J-1 intern or training program meets the English proficiency requirements outlined in 22 CFR 62.20(b), please submit proof as PDF #10 aligned with their chosen “objective measurement” as indicated in PDF #9. If #1-14 is chosen, ensure that the proof meets the minimum score requirement. If #15 is selected, have PDF #10 completed and signed by an authorized individual. If #16 is elected, submit the applicant’s elementary and high school transcripts or equivalent to show they were born and raised in one of the listed countries.
Returnwww.fusia.net/englishproof
To school. $user_pname_ek is seeking to participate in the US Department of State’s Exchange Visitor Program but lacks the necessary documentation to support their English proficiency. They are seeking your assistance in completing and signing the form to fulfill this requirement through alternative means: “by signed documentation from an academic institution or English language school or through a documented interview conducted by the sponsor either in-person or by videoconferencing, or by telephone if videoconferencing is not a viable option.”
1 This interview is conducted by
☐ A professor who has given English lectures to the student
☐ A staff or authorized individual from FUSIA
☐ A staff from the applicant’s school (international office, career office, etc., English-speaking facility only)
On _____ (month) / _____ (day) / _____ (year) via ☐ In-person ☐ Videoconferencing ☐ Telephone
2 Interview and scores Engage in an dialogue with the applicant. Ask them three questions (samples and/or own questions) that mirror daily internship situations in an American setting, then indicate the rating. A score of 2.0 on a 4-point scale is the minimum requirement (1.0+ unsatisfactory, 2.0 + understandable with repetition, 3.0+ understandable without repetition, 3.5+ excellent as a nonnative speaker, 4.0 excellent like a native speaker).
☐ How did you learn English? What other languages do you speak? ................................ Comprehension ____ Fluency ____
☐ What motivates you to pursue an internship in the US? ............................................... Comprehension ____ Fluency ____
☐ What would be the most challenging aspect of living and interning in the US? ............ Comprehension ____ Fluency ____
☐ How do you think that the internship will benefit you personally and professionally? .. Comprehension ____ Fluency ____
☐ ______________________________________________________________________________________ Comprehension ____ Fluency ____
☐ ______________________________________________________________________________________ Comprehension ____ Fluency ____
☐ ______________________________________________________________________________________ Comprehension ____ Fluency ____
3 Verdict Check HERE ☐ to indicate that you agree that the applicant possesses sufficient English language skills necessary to successfully participate in their program and to function on a day-to-day basis.
Interviewer’s signature or school/department stamp
_______________________________ __________________________________________ ___________________________________________________
Signature $date_sign EST .... Name of the verifier .................................. Email associated with the listed institution
__________________________________________________________ __________________________________________________________________
Title and department ........................................................ Organization or school
1 This interview is conducted by
☐ A professor who has given English lectures to the student
☐ A staff or authorized individual from FUSIA
☐ A staff from the applicant’s school (international office, career office, etc., English-speaking facility only)
On _____ (month) / _____ (day) / _____ (year) via ☐ In-person ☐ Videoconferencing ☐ Telephone
2 Interview and scores Engage in an dialogue with the applicant. Ask them three questions (samples and/or own questions) that mirror daily internship situations in an American setting, then indicate the rating. A score of 2.0 on a 4-point scale is the minimum requirement (1.0+ unsatisfactory, 2.0 + understandable with repetition, 3.0+ understandable without repetition, 3.5+ excellent as a nonnative speaker, 4.0 excellent like a native speaker).
☐ How did you learn English? What other languages do you speak? ................................ Comprehension ____ Fluency ____
☐ What motivates you to pursue an internship in the US? ............................................... Comprehension ____ Fluency ____
☐ What would be the most challenging aspect of living and interning in the US? ............ Comprehension ____ Fluency ____
☐ How do you think that the internship will benefit you personally and professionally? .. Comprehension ____ Fluency ____
☐ ______________________________________________________________________________________ Comprehension ____ Fluency ____
☐ ______________________________________________________________________________________ Comprehension ____ Fluency ____
☐ ______________________________________________________________________________________ Comprehension ____ Fluency ____
3 Verdict Check HERE ☐ to indicate that you agree that the applicant possesses sufficient English language skills necessary to successfully participate in their program and to function on a day-to-day basis.
Interviewer’s signature or school/department stamp
_______________________________ __________________________________________ ___________________________________________________
Signature $date_sign EST .... Name of the verifier .................................. Email associated with the listed institution
__________________________________________________________ __________________________________________________________________
Title and department ........................................................ Organization or school