Request Form for Help with J-1 and H-1b Visa-related issues by APPNA Advocacy/Legislative & Young Physicians Committees
I hereby authorize the APPNA Advocacy/legislative and Young Physicians Committees to contact US Congressmen, My training program, U.S Department of State, and other US Government & legislative authorities (as deemed necessary) on my behalf.
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Name (First and Last) *
Email *
Date of Birth *
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Gender *
Visa Type *
Reason for Visa Application *
Visa Status *
Passport Country Name *
Passport Number *
Visa Processing Number *
Place (City) of Visa Interview *
Date of Interview (month, day, year) *
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DD
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Name of Medical College *
USA Training Program Name *
USA Training Speciality (e.g., Internal Medicine, etc.) *
USA Training Program City *
USA Training Program State *
USA Training Program Director (PD) Name *
USA Training PD/Coordinator Phone Number *
USA Training PD/Coordinator E-mail *
Brief Description of Events *
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