Rutgers Biomedical and Health Sciences International Services
65 Bergen Street, Room #GA-72, Newark, NJ 07101
973-972-6138 (phone)
973-972-8260 (fax)
J-1 Travel Authorization Form
This form must be completed by J-1 Exchange Visitors requesting a travel endorsement on their DS-2019. Please complete this form
and return it to the International Services office at least two weeks prior to the date of intended travel. Your supervisor must sign
certifying that the requested travel is approved.
Date
I. To be completed by Exchange Visitor
Family name
First name
Current street address
Apt. #
City
State
Zip
Telephone number (home)
Telephone number (cell)
Department name
Campus location:
Newark
Travel dates: From
Piscataway
to
New Brunswick
Camden/Stratford
Destination country
Purpose of travel
II. To be completed by supervisor
By signing this form, I certify that
(name of department)
is employed in the
department as of
(date)
He/She has permission to travel during the dates outlined above and is expected to resume employment at RBHS.
Supervisor's signature
Print name
Phone number
email address