STUDENT REPORT YOUR NAME: __________________________________ HOME COUNTRY: ___________ ACADEMIC INSTITUTION:____________________________________________________ CURRENT E-MAIL: _______________________ ADDRESS (IN U.S.):_________________ CURRENT PHONE (IN U.S.): ________________ ADDRESS (IN U.S.): _________________ SECTION A - ACADEMIC REPORT
Please list the two courses you have registered to take. TITLE OF COURSE CREDITS GRADE
Fall Semester: If your host institution operates on the quarter system, please list your course(s) here: TITLE OF COURSE CREDITS GRADE
Fall Quarter: SECTION B – ENDORSEMENT OF ACADEMIC ADVISER ___________________________________________________________________________
Name of Academic Adviser Email Telephone I have reviewed the above description of the FLTAs study plan. I understand that this FLTA must be taking two courses per semester in addition to their FLTA duties in order that they maintain their status under the J-1 visa regulations. ___________________________________________________________________________
Signature of Academic Adviser ____________________________________ _________________________ FLTA Signature Date
Please photocopy for your records and return completed form to: FLTA Program,
Institute of International Education
809 United Nations Plaza,
New York, NY 10017
Fax: (212) 984-5578
or email to FLTA@iie.org. |
