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Acknowledgement of Fees You Paid for Participation in the J-1 Program

This form will provide evidence that all IEE’s J-1 participants are aware of all fees that are to be paid for the participation in the exchange visitor program. Please report all fees paid in relation to this exchange visitor program as listed below:

Fee paid to Agency in home country:    USD

Fee paid directly to IEE:                         USD
(if not using an agency in your home country)  

IEE's Monthly Insurance Rate:             USD   $  50.00

Fee paid for SEVIS:                              USD

Fee paid for the visa application:          USD

Fee paid for travel to the U.S.:              USD

Please list the amount of any other fees you have paid related to participation in this program that is not listed above: 


What are these fees to cover? 

Your Name:

Home Country Agency Name (If applicable): 

Placement location: 

Intern/Trainee: Non Refundable Application Fee: $250.00

Additional Fees Charged:
Funds withheld if Exchange Visitor withdraws from the program prior to DS issue: $500.00
Funds withheld if Exchange Visitor withdraws from the program after DS is issued: $650.00
Funds withheld due to a visa denial: 50% of program fees – insurance fees will be reimbursed
No refund if Exchange Visitor withdraws after visa issuance. No exceptions
No refund once Exchange Visitor enters the U.S. No exceptions
No refund if DS form is returned after the start date on the DS-2019 form.

Note: Original DS form must be returned within 10 days of visa denial or program withdrawal to receive refund. Refunds will not be issued if the DS-2019 form is not returned or received within 10 business days of denial or withdrawal – No exceptions  No refund will be issued 30 days or more after the denial.

Refunds will be issued as indicated on the refund request form and it is the responsibility of the participant or participant’s agency to submit the complete and accurate refund request form. Payments made through an Agency will be refunded to that Agency for further distribution unless another method is requested in writing by participant and agency. 

IEE's refund fees do not include any fees that may be charged by your agency in your home country, if applicable.

Below are additional fees that may be applicable during your program:

DS-2019 replacement fee: $350.00
​If your visa is denied and you would like to reapply, there will be a $250.00 charge to re-submit your documents to include shipping
Transfer Fee (Transfers are not guaranteed and are not to be expected, but handled on a case by case basis): $400.00
Travel Validation: $50.00
Extension Fees: $800.00 + insurance
Insurance Fees are $55.00 per month

By hitting the submit button, you, being the applicant for the exchange visitor program (J-1 visa),  are certifying that the information above is correct to the best of your knowledge and you are acknowledging our visa denial fee and any additional fees that IEE may charge you as it relates to your program.

In addition, you, being the applicant for the exchange visitor program (J-1 visa) are certifying that you have personally completed this form and you are personally responsible for the information being submitted.

Did you take out a loan to assist you with any portion of the fees associated with this program?
If yes, state the amount and the pay back terms: