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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

7 of 9

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

1-888-COUNCIL (268-6245)

  [e-mail] 

Updated:  8/8/17

position, but CIEE makes no guarantee with respect to being 

able to do so. Nor does CIEE make any representation that 

it will be able to find work for the participant in the same 

geographical area or the same type of work or pay as the 

original CIEE-sourced job.

35.  In the case of a change of job or of premature termination 

of job, or if the employment is terminated before the end of 

the program for any reason, or if the participant decides to 

return home early, no fees will be refunded.

36.  If a participant is fired from his or her job for violation of 

employer policies, including, but not limited to, his/her failure 

of a company-required drug test at the commencement 

of or anytime during employment, he or she have their 

program shortened with no refund of program or CIEE Job 

Service fees.

37. If the participant’s original job ends before the legal working 

dates listed on the DS-2019 for any reason, it is the partici-

pant’s responsibility to inform CIEE and get approval for any 

new job.

Responsibility

38.  This English language version of the Contract is the binding 

contract between the participant and CIEE.

39.  CIEE makes no presentation or warranty of any kind, 

expressed or implied, as to the suitability of the program for 

any participant, and CIEE disclaims all such warranties to the 

full extent of the law.

40. The conduct of the Work &Travel USA program is subject to 

U.S. government approval and may change without notice.

41.  The participant understands that perceived or actual epi-

demics (such as, but not limited to, SARS or bird flu) can 

seriously delay, disrupt, interrupt, or cause the cancellation 

of entire programs. The participant agrees to assume all risks 

and losses (including financial) that result from any such 

occurrence.

42.  CIEE does not own or operate any entity that is to or does 

provide goods or services for the program including, for 

example, arrangements for or ownership or control over 

houses, apartments, or other lodging facilities, airline, ves-

sel, bus, or other transportation companies, food service 

or entertainment providers, etc. All such persons and enti-

ties are independent contractors. As a result, CIEE is not 

liable for any negligent or willful act or failure to act of any 

such person or entity, or of any third party. Without limita-

tion, CIEE is not responsible for any injury, loss, or damage 

to person or property, death, delay, or inconvenience in 

connection with the provision of any goods or services 

occasioned by or resulting from, but not limited to, acts of 

God, force majeure, acts of war, or civil unrest, insurrection 

or revolt, strikes or other labor activities, criminal or terror-

ist activities, or the threat thereof of any kind, overbooking 

or downgrading of accommodations, structural or other 

defective conditions in houses, apartments, or other lodging 

facilities (or in any heating, plumbing, electrical, or structural 

problem therein), mechanical or other failure of airplanes 

or other means of transportation, or for any failure of any 

transportation mechanism to arrive or depart timely or 

safely, dangers associated with and/or bites from domestic 

or wild animals, pests or insects, sanitation problems, food 

poisoning, disease, epidemics, or the threat thereof, lack of, 

access to, or quality of medical care, difficulty in evacuation 

in case of medical or other emergency, or for any other 

cause beyond the direct control of CIEE. In addition, partici-

pant releases CIEE from its own negligence.

43.  CIEE reserves the right, but is not obligated, to provide 

participants with information CIEE deems useful to program 

participants, including but not limited to tax, travel, and 

related services.

44. CIEE retains the right, in its sole discretion, to contact partic-

ipant’s school, parents and/or guardian with regard to health 

issues or any other matter whatsoever which relates to par-

ticipant or participant’s program. These rights transcend any 

and all privacy regulations that may otherwise apply.

CIEE Program-Related Conditions

45.  CIEE reserves the right to refuse sponsorship of any appli-

cant that CIEE deems not to meet the program eligibility 

requirements or any applicant that CIEE does not deem 

appropriate to accept in the general interests of the pro-

gram. In the event that CIEE refuses an applicant acceptance 

on the program, any refund will be made via the CIEE 

Representative through whom the original application was 

submitted.

46.  Participation on the program begins when the participant 

legally enters the U.S. and, subject to this contract, termi-

nates on the day of departure from the U.S. (within the legal 

program dates). Participation on the program will end a 

maximum of five months from arrival in the U.S. Participants 

can arrive five days prior to their DS-2019 start date and 

remain in the U.S. up to 30 days beyond their DS-2019 end 

dates as long as their total stay in the U.S. does not exceed 

five months. Participants must return to their home country 

in time for the start of their university classes.

47.  CIEE may issue a DS-2019 Form if a participant meets the 

Work & Travel USA program requirements, but cannot guar-

antee that the U.S. Embassy or Consulate in a participant’s 

country of residence will issue a J-1 Visa.

48.  Once a participant has commenced his/her travel to the 

U.S., CIEE cannot amend the program dates as listed on the 

DS-2019 for any reason. It is the participant’s responsibility 

to check prior to travel that the dates are correct.

49. Individuals who have recently held a J-1 Visa for the U.S. may 

have to remain in their home country for a minimum of 90 

days before CIEE can issue a DS-2019 for Work & Travel USA. 

Please contact your local CIEE Representative and local U.S. 

Embassy for details.

50.  CIEE reserves the right to access U.S. Form I-94 entry and 

exit information for the purpose of monitoring program 

status.

51.  Insurance is provided for the dates confirmed by CIEE, by 

the CIEE insurance provider, as a mandatory part of the CIEE 

program for each applicant. It is the responsibility of each 

participant to purchase further insurance should he or she 

extend his or her period abroad for any reason. CIEE cannot 

be held responsible for any insurance claim in the event that 

a participant has failed to secure adequate insurance.

52.  Under the U.S. government’s Health Insurance Portability and 

Accountability Act (HIPAA), CIEE is restricted in its access 

to certain medical information or records in the event that 

a participant has an accident in the U.S. In order for CIEE 

to assist participants to the fullest extent possible with any 

insurance-related issues, CIEE must have a signed Privacy 

and Confidentiality Release Form from the participant which 

form waives the HIPAA confidentiality obligations. This form 

is optional and the participant can choose whether or not 

CIEE is granted access to this information. This release form 

and additional information about the HIPAA requirements 

are included as part of the Work & Travel USA application 

package. If you did not receive this information or release 

form, please contact your CIEE Representative. 

53.  All exchange visitors also may be subject to the requirements 

of the Affordable Care Act.

54.  CIEE reserves the right to dismiss from the Program any 

participant who is deemed by CIEE to be a danger to himself/

herself or others or whose conduct is deemed to be detri-

mental to the Program. In the event of such a dismissal, CIEE 

shall not be held responsible for any airfare, charges or any 

other expense incurred by the participant, and shall not be 

required to return any fees paid by the participant.

55.  CIEE reserves the right to utilize publicly available informa-

tion, including social media, that has not been directly 

provided by the participant. Information obtained through 

these means can be used as a basis for withdrawal, denial of 

a job offer, and/or any decisions made by CIEE affecting the 

participant’s program. 

56.  Once the participant has departed for the U.S., there will be 

no refund should the participant leave the program. There 

will also be no refund should CIEE withdraw sponsorship.

57.  The participant agrees to notify CIEE if he or she completes 

his or her program early and departs the U.S. prior to the 

end date listed on his or her DS-2019 Form.

58.  CIEE and your representative do not provide housing, 

though may provide housing suggestions. If the participant’s 

employer provides housing, it may be on a first-come, first-

served basis. The participant must notify CIEE if he or she 

has any concerns regarding the safety and/or suitability of 

the housing provided by his or her employer. If the partici-

pant arranges housing independently, he/she agrees to use 

his/her best judgment in securing housing that is safe and 

suitable. Housing arrangements that involve overcrowding 

and/or hot-bunking (multiple individuals using one bed and 

sleeping in shifts) are strictly prohibited. If the participant 

has any doubt about the suitability of his/her housing, he/she 

must notify CIEE immediately.

59.  If CIEE deems, in its sole discretion, or if it is advised by the 

State Department that a participant’s housing and/or work 

placement is unsafe or unsuitable, participant agrees to 

cooperate fully with CIEE to relocate to new housing and/

or work placement without delay. Failure to cooperate may 

result in action by CIEE up to and including termination of a 

participant’s program and requiring the participant to return 

home immediately.

60. CIEE may provide the participant’s contact information 

to third parties who often provide useful services to 

exchange program participants. Third parties receiving this 

information will be required to provide the participant the 

opportunity to opt out of further communications after the 

first contact.

61.  The participant gives CIEE permission, without the payment 

of consideration, to use any written, photographic, or video 

images of himself/herself in the course of reporting on and/

or promoting CIEE programs.

Binding Arbitration

62.  I agree that any dispute or claim which refers or relates to 

this contract, any literature related to the Program, or the 

Program itself, shall be litigated solely and exclusively in and 

for courts in Portland, Maine, subject to substantive and pro-

cedural Maine law, and for this limited purpose, the parties 

agree to exclusive venue and personal jurisdiction therein. 

At the Participant’s option, however, in lieu of litigation, CIEE 

will agree to binding arbitration in Portland, Maine, subject 

to substantive but not procedural Maine law, pursuant to the 

then existing commercial rules of the American Arbitration 

Association. In any such arbitration, the arbitrator and 

not any federal, state, or local court or agency shall have 

exclusive authority to resolve any dispute relating to the 

interpretation, applicability, enforceability, conscionability, or 

formation of this contract, including but not limited to any 

claim that all or any part of this contract is void or voidable.

I confirm that the statements contained in this application form are accurate to the best of my knowledge, and I understand and accept the 

Terms and Conditions.

Participant’s Name:

Participant’s 

Signature: 

Date 

(DD/MM/YYYY)

: 

For future reference, please make a copy of the above Terms & Conditions.

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