Summer Work and Travel usa application istplus com/watusa Congratulations on applying for Summer Work and Travel! Next Steps

Name of CIEE Representative:

Country:

Interviewed by (Name):

Representative Code:

Date (day/month/year):

WORK & TRAVEL USA

APPLICATION

A Cultural Exchange Program 

Summer 2018

2 of 9

ciee.org/in-the-usa/work/work-travel-usa

1-888-COUNCIL (268-6245)

  [e-mail] 

Updated:  8/8/17

OTHER VISA INFORMATION

Have you ever been denied entry into the U.S.? 

  

Yes* 

    

No 

Have you ever applied for a visa to immigrate permanently to the U.S.? 

  

Yes* 

    

No 

Have you ever been refused a visa by a U.S. Embassy? 

  

Yes* 

    

No 

Have you ever been arrested and/or convicted of a crime in your home country? 

  

Yes* 

    

No 

Have you ever been arrested and/or convicted of a crime in the U.S.? 

  

Yes* 

    

No 

*If you answered Yes to any of these questions, please contact your CIEE Representative.

UNIVERSITY/COLLEGE

Name of Institution (e.g., university, polytechnic):

City:

Major Field of Study:

What is the course length of your major field of study (in years)?

How many full semesters of university study have you already completed?

How many years of university study will you have completed by the time of your departure to the U.S.?

Will you be a full-time university student at the time you leave for the U.S.? 

  

Yes 

    

No

Will you be a full-time university student when you return to your country of residence? 

  

Yes 

    

No

PROOF OF STUDENT STATUS 

(This section must be completed by an official from your educational institution. If your educational institution will not sign this form, 

you must attach an official letter in English on university letterhead verifying this same information.)

Option A: Student Not in Final Year of Study

 

I certify that the named student has, as of this date, successfully completed at least one semester (or equivalent) of post-secondary 

academic study, is registered in our institution as a full-time student for the current academic year, and is returning to full-time studies in 

the semester following the program. Additionally, I certify that in order to continue his/her studies, this student will be taking classroom-

based courses requiring his/her physical presence in the country in which our institution is located.

Option B: Student in Final Year of Study

 

I certify that the named student has, as of this date, successfully completed at least one semester (or equivalent) of post-secondary 

academic study, is registered in our institution as a full-time student and is expected to graduate from our institution at or before the end 

of this academic year.

Name of Student:

Name of the Official Signing the Form: 

Title:

Signature:

School 

Seal/Stamp: 

Date 

(DD/MM/YYYY)

:

 

See additional proof of student status documents attached.

IST Plus

IST Plus

United Kingdom

UK/IST

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Name of CIEE Representative:

Country:

Interviewed by (Name):

Representative Code:

Date (day/month/year):

WORK & TRAVEL USA

APPLICATION

A Cultural Exchange Program 

Summer 2018

3 of 9

ciee.org/in-the-usa/work/work-travel-usa

1-888-COUNCIL (268-6245)

  [e-mail] 

Updated:  8/8/17

ENGLISH LANGUAGE ABILITY 

(This section must be completed by an English teacher or a pre-approved agency staff member.)

Oral English Ability 

1

      

Beginner  2

      

Intermediate  3

      

Advanced

Written 

English 

1

      

Beginner  2

      

Intermediate  3

      

Advanced

Listening Comprehension 

1

      

Beginner  2

      

Intermediate  3

      

Advanced

Additional comments about the student’s knowledge of English and his/her ability to function in an English-speaking workplace:

Name 

(Please Print)

:

Name of Educational Institution 

(Please Print)

:

Signature: 

Date 

(DD/MM/YYYY)

:

APPLICANT PERSONAL STATEMENT

Explain why you want to participate in the Work & Travel USA program.

How do you think your life in the United States will be similar to or different from your life at home?

During your time in the United States, please explain what you hope to: 

1. See

2. Learn

3. Experience

APPLICANT DECLARATION OF INTENT

I understand the objectives of the CIEE Work & Travel USA program as a U.S. Department of State authorized Exchange Visitor Program. I 

attest that I am applying for this program with the intent to participate in American cultural activities and to interact with American citizens. 

I will, to the best of my ability, participate in any cultural activities arranged by CIEE or my employer, and will actively seek out opportunities 

to interact with Americans and participate in cultural activities independently. I understand that failure to uphold the intent of this cultural 

exchange program and comply with program rules and regulations could result in the withdrawal or termination of my J-1 visa status, which 

would require my immediate return home.

Applicant’s Name (Please Print):

Applicant’s 

Signature: 

Date 

(DD/MM/YYYY)

:

IST Plus

*UK nationals do not need to 

complete this section

*

ALL APPLICANTS MUST COMPLETE THIS SECTION

IST Plus

United Kingdom

UK/IST

---