Option 1 Signed Documentation
To applicant. After completing , generate this document and contact your school’s relevant department (e.g., Registrar, Career Office, International Office) to have the form completed.
Have ADMIN review the form before requesting a school signature or stamp.
To school. () is applying for
J-1 Internship in the United States through FUSIA, a J-1 visa sponsor designated by the US Department of State. We request your assistance in verifying the information below to confirm eligibility by completing, stamping, and signing the form. Alternatively, you may provide a stamped or signed letter on official letterhead — just ensure all required items (highlighted in blue) are addressed.
We verify that the information below is accurate and complete.
☑ Yes ☐ No () is either (1) a
full-time student actively pursuing studies at (), or (2) has completed a
degree or certificate at . expected/actual graduation date (mm-dd-yyyy) is either on or after, or within 12 months before, their internship program start date .
☑ Yes ☐ No is a
ministerially-recognized degree- or certificate-granting post-secondary academic institution located outside the United States.
☑ Yes ☐ No was admitted to on (mm-dd-yyyy). They are enrolled in year of a -year program at and currently hold a cumulative GPA of on a scale.
☑ Yes ☐ No is pursuing or has completed a (postsecondary degree or certificate type). . Their declared field of study, , is deemed aligned with their academic pursuit.
___________________________________________________________________________________________________________________________
School/Department Stamp and/or Authorized Signature - signed/stamped on
07-03-2025 EST (mm-dd-yyyy)
_____________________________________________________________ _____________________________________________________________
Name of the Verifier ..................................................... School-Issued Email (no personal email)
_____________________________________________________________ _____________________________________________________________
Title .............................................................................. Department
*“To be declared” specializations are acceptable if they reflect academic intent in good faith. If the connection between “Field of Study” and academic background is unclear, may list “Multi/Interdisciplinary Studies” to reflect a broader academic scope.
