J-1 IRISH WORK TRAVEL PILOT PROGRAM FOR IRELAND 2019 APPLICATION FORM Step 1 of 7 14% Please Have Required Documents Ready for Upload in Order to Complete Form Your program start date must be within 12 months of your final class at your University. SIGNED & STAMPED COPY OF PROOF OF COLLEGE. PDF Format. (Download link) SIGNED COPY OF RULES & REGULATION FORM. PDF Format. (Download link) CV or RESUME. PDF Format BIOGRAPHICAL PAGE OF PASSPORT. SCANNED JPEG. WE DO NOT ACCEPT SMARTPHONE PHOTOS. PROOF OF FUNDS, e.g. RECENT BANK STATEMENT. MUST SHOW APPLICANT'S NAME. PDF Format. COPY OF PREVIOUS US VISAS IF APPLICABLE. PDF Format. COPY OF IRISH VISA (THIRD PART NATIONALS) IF APPLICABLE. PDF Format PERSONAL INFORMATIONImportant! This information must appear exactly as it does on your passport.Full Name* First Middle Last Date of Birth* American Date Format: mm/dd/yyyyPlace of Birth*Nationality*Citizen of*must be a citizen of IrelandPermanent Resident of*If you have graduated, are you currently working?YesNoPERMANENT ADDRESSAddress*Town/City*County/PostCode*Country*Phone*Mobile*Email* Enter Email Confirm Email EMERGENCY CONTACTName* First Last Relationship to Participant*Address*Town/City*County/PostCode*Country*Phone*Mobile*Email* Enter Email Confirm Email COLLEGE ATTENDANCE DETAILSCOLLEGE ATTENDANCE DETAILSCollege*College Address*Degree/Diploma/Certificate Course*(Eg. Bachelor of Business Studies BSc Business, Masters of Elkectrical Engineering MSc Engineering)Date of Final Class* American Date Format: mm/dd/yyyy VISA AND TRAVEL INFORMATIONPERSONAL REFERENCEName* First Last Relationship*Address*Email* Enter Email Confirm Email Contact Number*PROFESSIONAL REFERENCEName* First Last Relationship*Name of Company or Organisation*Address*Email* Enter Email Confirm Email Contact Number*VISA AND TRAVEL INFORMATIONHave you ever received a J-1 visa to enter the US?*YesNoIf yes, please fill out the following for each visa:How many times?Please enter a value between 1 and 2.Name of Program*Number*Sponsoring Organisation*Dates of Previous DS-2019: Start Date* American Date Format: mm/dd/yyyyDates of Previous DS-2019: End Date* American Date Format: mm/dd/yyyyName of Program*Number*Sponsoring Organisation*Dates of Previous DS-2019: Start Date* End Date* Have you ever received a J-1 Intern visa to enter the US?*YesNoIf yes, please fill out the following for each visa:Name of Program*Number*Sponsoring Organisation*Dates of Previous DS-2019: Start Date* End Date* Have you ever applied for a visa to immigrate permanently to the US?*NoYesSelect Yes or NoHave you ever been arrested or convicted of a crime?*NoYesSelect Yes or NoDo you have any health issues that might be a barrier to success?*NoYesSelect Yes or NoINTENDED START/COMPLETION DATESNB: When entering in Program Start Date please allow up to 4 weeks for application processing from application submission date now. Also you may enter the US 4 weeks before Program Start Date. We recommend availing of this time to secure internship if you do not already have it organised. Intended Flight to US Travel Date* Preferred start date of program (actual on-program dates)* Note: you can enter up to 30 days prior to the date above. This is the earliest date you can start your Intern position.Preferred end date of program (actual end-of-program date)* Note: your program allows a 12 month opportunity and you can depart up to 30 days after the date aboveIntended Destination City*Where do you intend to do your Internship? EXPECTATIONSHow did you first learn of the J-1 IWT Program?*What attracted you to the J-1 IWT Program and what do you expect to gain?*What about the J-1 IWT Program do you believe will prove most beneficial upon return to your home country?*INTERNSHIP INTERESTSDescribe your ideal internship?*Have you begun to look for an internship?* HISTORIC, SOCIETAL, CULTURAL INFORMATION The United States Department of State believes that a participant coming to the United States on a J1 Program – should not only gain a valid internship to help with their future career – but should also gain a better understanding of America and it’s History, Society & Culture. We agree!! Tell us a little bit about what might interest you while you are here and we will develop a program of learning for you. (check all that apply).HISTORIC, SOCIETAL, CULTURAL INTERESTS INFORMATIONcheck all that applyHistory The American Revolution 19th Century Industrialization 20th Century Society The Political System Local Politics Volunteering Opportunities Culture African American Culture Native American Culture Other Cultures Sports American Football Baseball Basketball Bowling Cycling Horse Racing Soccer Softball Swimming Track & Field The Arts Art Galleries Movies Music** Theater Literature * **What genre of Music? APPLICATION CHECKLIST SIGNED & STAMPED COPY OF PROOF OF COLLEGE PDF SIGNED COPY OF RULES & REGULATION FORM PDF CV or RESUME PDF REFERENCES PDF PASSPORT JPEG PROOF OF FUNDS PDF COPY OF PREVIOUS US VISAS IF APPLICABLE PDF COPY OF IRISH VISA (THIRD PART NATIONALS) IF APPLICABLE PDF PROOF OF COLLEGE PDF, RULES & REGULATION,CV or RESUME, PROOF OF FUNDS, COPY OF PREVIOUS US VISAS IF APPLICABLE, COPY OF IRISH VISA (THIRD PART NATIONALS) IF APPLICABLE* Drop files here or Accepted file types: pdf. Upload Required PDF Documents. Allow time for documents to upload (Max file sizes: 2MB).PASSPORT JPEG* Drop files here or Accepted file types: jpg. Upload Required JPG. Allow time for documents to upload (Max file size: 2MB).Check* Proof of College (pdf, correct orientation) Check* Rules & regulations signed (pdf – 1-doc, 2-pages, correct orientation) Check* CV or Resume (pdf, correct orientation) Check* Photocopy of Personal Details in your Passport (JPEG – professionally scanned, correct orientation) Check* Proof of Funds (> $1500) (pdf, correct orientation) Check if applicable Copy of Previous US Visas (if applicable) (pdf, correct orientation) Check if applicable Copy of Irish Visa (Third Country Nationals) (pdf, correct orientation) PhoneThis field is for validation purposes and should be left unchanged.