Note: New J-1 Interns that need a visa must have their visa before they can start working for the University. Please allow for a minimum of three months to obtain a visa (e.g., if the offer is accepted on August 1, the start date should be at least November 1). Provide additional time, if possible.
To begin this process, the sponsoring faculty member requests approval of Department Head an then provides the following information to administrative assistant, Johey Verfaille.
- Name of J-1 Intern:
- Email:
- Training/internship field:
- Description of activity:
- Start date:
- End date:
- CIP code for this visit:
- Frequently Used IST CIP codes:
- Data Sciences and Artificial Intelligence: 11.0102 Artificial Intelligence
- Privacy and Security: 11.1003 Computer and Information Systems Security/Auditing/Information Assurance
- Human Computer Interaction: 11.0105 Human-Centered Technology Design
- Social and Organizational Informatics: 11.0104 Informatics
- College of Information Sciences and Technology: 11.0401Information Sciences/Studies
- Department/institute: Penn State University
- Department website URL:
- Does this intern have sufficient English skills to participate in the internship?
- Does this person have less than 5 years of work experience?
- Number of hours per week (min 32/max 40):
- Will this intern be paid?
- Will this internship include any clerical activities?
- Will this internship require any patient, elder or childcare?
- Has the supervisor read and agreed to the requirements regarding interns (including the focus on cultural exchanges) as listed in the Hosting International Interns brochure?
Program Information
Please provide a summary of the internship goals (e.g., Learn research techniques in X subject area):
- Description of trainee/intern's role for this program or phase:
Specific goals and objectives for this program or phase1: **
- Phase 1 date start/finish:
- List the names and titles of all supervisors providing daily oversight (including the host supervisor) and their qualifications to teach the planned learning:
- List specific examples of how the J-1 Student Intern will participate in American culture during this experience (e.g., field trips, social activities, local events, etc.):
- List specific knowledge, skills, or techniques that will be learned:
- List specific tasks, activities, and training methods for the above skills to be learned:
- List how these new skills and competencies will be measured:
- Specific goals and objectives for this program or phase1:
Specific goals and objectives for this program or phase2: **
- Phase 2 date start/finish:
- List the names and titles of all supervisors providing daily oversight (including the host supervisor) and their qualifications to teach the planned learning:
- List specific examples of how the J-1 Student Intern will participate in American culture during this experience (e.g., field trips, social activities, local events, etc.):
- List specific knowledge, skills, or techniques that will be learned:
- List specific tasks, activities, and training methods for the above skills to be learned:
- List how these new skills and competencies will be measured:
- Specific goals and objectives for this program or phase 2:
- Will the intern be enrolled in Penn State courses?
- Will the intern be a Penn State employee? No. If yes, explain
**Phases may last up to 6 months:
- Months 0 to 6 are one phase
- Months 7 to 12 are another phase or more. This requires another submission of this form.
For example, you are required to submit this form twice for an intern spending eight months at Penn State: once for months 0 to 6, and once for months 7 and 8.
A phase change reflects a change in the internship’s process or development.
