JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
J Visa Holder Registration Form
J Visa Holders (J1 and J2) within the last 10 years are requested to register with us through this form.
All information will be kept confidential.
This registry will help us keep you informed of important developments on Philippine policies and regulations regarding the U.S. Exchange Visitors Program. It will also help us contact those who have remain in the United States in case of emergency.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
NAME:
*
Your answer
RESIDENTIAL ADDRESS:
*
Your answer
CATEGORY (INTERN, TEACHER, STUDENT, PHYSICIAN, DEPENDENT, etc.) :
*
Your answer
DATE OF FIRST ARRIVAL IN THE UNITED STATES:
*
MM
/
DD
/
YYYY
SPONSORING INSTITUTION (You may write more than one) :
*
Your answer
HOST ORGANIZATION (You may write more than one) :
*
Your answer
LOCAL AGENCY IN THE PHILIPPINES:
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Philippine Embassy, Washington, D.C..
Report Abuse
Forms
