J-1 Waiver Packet Checklist

All listed information and documentation must be submitted in order to be considered for a waiver slot. Waiver requests that do not comply with these requirements will not be entered into the State’s waiver review process and will be returned. 

The following is a list of required information and documents to be submitted for a waiver recommendation under the ND J-1 Visa Waiver Program. 

Documents should be placed in the waiver application packet in the following order:

1. Letter from the employer (facility letter) which must include a description of the J-1 Physician’s responsibilities, hours worked (40 hours are required), and location(s) where physician is expected to work.
    
2. HPSA/MUA Evidence Documents
   • If the waiver application is for a non-designated flex waiver, a detailed description of how the J-1 Physician will serve the medically underserved population must be included.
      
   • If the waiver application is for a designated HPSA/MUA, please include the HPSA/MUA Identification number.
      
3. Employment contract: signed and dated contract of full-time employment (40 hours/week), for a term of three years; the physician agrees to begin employment at the approved site within 90 days of receiving the J-1 visa waiver. Details related to the facility name(s) and each address where the applicant will be working must be in the contract. 
    
4. DS-2019’s/ I-94
    
5. Exchange visitor attestation/ Foreign Medical Graduate Statement
    
6. Form G-28 or letter from law office 
    
7. DS-3035 and supplementary applicant information 
    
8. Statement of Reason
    
9. Third Party Barcode Page
    
10. Waiver Division Barcode Page
     

QUESTIONS

Any questions about the North Dakota J-1 Visa Waiver Program should be directed to the Center for Rural Health, UND School of Medicine and Health Sciences, 1301 N. Columbia Road Stop 9037, Grand Forks, ND 58202-9037. Contact email: stacy.kusler@med.und.edu.

• Include ONE (1) copy of the application packet. This information will be scanned and submitted electronically.  
   
• Do not include documents that are not required by DOS or the State of North Dakota.
   
• Please only use binder clips. Do not use staples, or metal prong fasteners. Do not use two-sided copies or pages larger or smaller than 8.5 x 11.
   
• The DOS waiver case file number should appear in the upper right corner on every page of the application.
   
• The packet needs to include a Table of Contents in the order listed above.
   
• Separate each document with a colored divider page, labeled with the numbers that coincide with the Table of Contents.