InterExchange Cooperator Interview Report Form

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Please complete the interview report form as you conduct the English language interview. This form should never be shared with applicants. Since you will need to upload this form to the online application, make sure you include your email address at the top so a copy will be emailed to you.

Your responses will be emailed directly to you once you submit this form.

Email *

Applicant Name *

Name of cooperator *

Do you consent to allow InterExchange to collect and use your personal data for the purposes of your InterExchange application and program? *

Yes

Why are you applying for a J-1 Intern/Trainee Visa program? Check all that apply and document any additional options not listed below. *

Training required by current employer in home country

Professional development/resume-building experience

Gain international experience

Improve language skills

Other:

Required

Is this internship required by your university? *

Yes

Name of University (if internship is required)

Comments/Notes:

Can you explain what education/experience you have and how you expect to apply it to the program? *

What are your future career goals, and how will this internship/training program help you to achieve these goals? *

What prior experience do you have living, working, studying, or traveling in the U.S.? Does this include a previous J-1 program? If yes, please specify which J-1 program and discuss that experience. *

Why did you choose to do an internship/training program in the U.S. (as opposed to another country or your home country) *

How do you plan to experience U.S. culture and participate in cultural exchange activities while you are in the U.S.? *

For Interviewer: Did your organization place this candidate in their internship/training program? *

Yes

If cooperator did not place participant, how did they find their host company?

Through a placement agency

I work/worked for a branch of this company in my home country/outside the U.S.

A professional colleague referred me

A friend/relative referred me

A previous intern/trainee referred me

I knew of the company already and contacted them directly

University

Website

InterExchange Host Employer Database

Other:

Clear selection

If they chose website, please list here.

Did you use any other websites/online resources to search for internships? *

Yes

What other websites were used?

Why did you choose to intern/train with this particular host company? *

Did anyone assist you in completing the application or in the application process? (Other than an authorized cooperator or host employer) *

Yes

Have you previously applied for sponsorship for this particular internship/training program with another sponsor (i.e. for this exact program--not a previous internship/training program)? *

Yes

Does the emergency contact listed on your application speak English? *

Yes

Clear selection

If you are not currently studying or working how have you been advancing your professional development in the time since graduation or your last job? *

Understanding the Program

Do you understand that, if approved, InterExchange, not your host employer, is your visa sponsor? *

Yes

Do you understand that, although your host employer may terminate their employment relationship with you, they do not have the authority to cancel your visa and that only the U.S. government or InterExchange may do so? *

Yes

Do you understand that, if your application is approved and you begin your program with InterExchange in the U.S., that you must contact InterExchange in the event that you experience an emergency or any problems throughout your program? *

Yes

Do you understand that, if approved, you must complete a mandatory online orientation? It is HIGHLY recommended that you complete this prior to coming to the U.S., and failure to complete the orientation within 10 days of arrival will result in dismissal from the program. *

Yes

Do you understand that, if approved, you must also contact InterExchange as soon as you have arrived in the U.S. (but no later than 10 days after) so we can activate your record in SEVIS. *

Yes

Do you understand that you are obligated to respond to any requests or inquiries sent from InterExchange, including monthly emails asking you to verify your contact information for SEVIS? *

Yes

Do you understand that the purpose of this program is for cultural exchange? *

Yes

Do you understand that secondary employment of any kind during your program is prohibited?

Yes

Clear selection

Do you understand that if you are approved, the dates on your DS-2019 Form are your firm program dates unless you contact InterExchange about having them changed PRIOR to your arrival in the U.S.? Once you have arrived in the U.S. and are activated in SEVIS, even if you experienced delays and/or started your program late, your end date cannot be changed. *

Yes

Do you understand that, if you wish to extend your program and meet the extension criteria, you must contact InterExchange to apply and submit your extension application 30 to 60 days before your program end date? If you have questions about extending your program, please contact InterExchange. *

Yes

Do you understand that you are required to leave the U.S. at the end of your J-1 Visa program? *

Yes

Do you understand that you are bound to all of the other items indicated in the Participant Agreement Form included in the application that you have signed and submitted? *

Yes

Do you understand that if you are approved, you must read the emails you will receive from InterExchange about your next steps? You will use the information and links in these emails to make an interview appointment at the U.S. embassy in your home country. Please review this information carefully to make sure you have completed everything and are able to begin your program. *

Yes

Do you understand that your accident & sickness insurance purchased by InterExchange will only cover medical treatment for unexpected injuries or illness? It will not cover routine annual exams or pre-existing conditions. *

Yes

Date *

YYYY

My signature confirms that I have interviewed this applicant in person and in English, and that I have obtained his or her consent to collect and use his or her personal data for the purpose of processing this application. *

The applicant's overall English skills are: *

Excellent (Fluent; understands questions all of the time, has clear responses, able to express him/herself clearly, demonstrates eagerness to speak English, and possesses sufficient English language skills to function on a day-to-day basis in the training environment)

Very good (Nearly fluent; understands almost everything, has mostly clear responses, able to express him/herself clearly most of the time, demonstrates eagerness to speak English, and possesses sufficient English language skills to function on a day-to-day basis in the training environment)

Good (Only understands questions/has clear responses some of the time, but possesses sufficient English language skills to function on a day-to-day basis in the training environment)

Fair (Only understands questions some of the time, rarely has clear responses and unable to clearly express him/herself; does not possess sufficient English language skills to function on a day-to-day basis in the training environment)

Poor (Rarely understands questions, rarely has clear responses and rarely able to express him/herself, does not possess sufficient English language skills to function on a day-to-day basis in the training environment)

Interviewer Recommendation: *

I strongly recommend this applicant

I recommend this applicant

I do not recommend this applicant

What was the format of the interview? *

In person

Phone

Webcam or Skype

Additional comments or concerns

A copy of your responses will be emailed to the address you provided.

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