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STUDENT INTERN ATTESTATION Oklahoma State University International Students Scholars 250 Student Union Stillwater OK 74078 Phone 405 744-5459 Fax 405 744-8120 http //iss. okstate. edu I am applying for a J-1 internship program at Oklahoma State University. I attest to the following I will return to the academic program at my institution in my home country to fulfill and obtain a degree after completion of this J-1 internship program at Oklahoma State University. STUDENT INTERN ATTESTATION Oklahoma State University International Students Scholars 250 Student Union Stillwater OK 74078 Phone 405 744-5459 Fax 405 744-8120 http //iss. okstate. edu I am applying for a J-1 internship program at Oklahoma State University. I attest to the following I will return to the academic program at my institution in my home country to fulfill and obtain a degree after completion of this J-1 internship program at Oklahoma State University. I will be evaluated by my OSU internship supervisor at the end of the internship program* If the internship is longer than 6 months I will also be evaluated at the mid-point of the internship program* I understand that the internship program cannot last longer than 12 months in duration* I will have sufficient finances to cover my living expenses of myself and my dependents for the duration of my internship program* I will have medical insurance for myself and my dependents for the entire duration of my J-1 program in accordance with the requirements set up by the U*S* Department of State. These requirements include that the insurance that I have will o Provide medical benefits of at least 50 000 for each accident or illness o Provide at least 7 500 in benefits if I or my dependents should die in the United States to send my/our remains to my home country for burial* o If because of serious illness or injury I must be sent home on the advice of a doctor the policy must pay up to 10 000 for the expenses of my travel* Application must include Copy of applicant s biographical information page of passport Copy of dependent s biographical information page of passport Certification of Academic Status signed by academic dean/adviser at the student intern s institution Copy of financial support for the duration of the internship if not paid by OSU Name of Student Intern Signature of Student Email of Student Intern Date. okstate. edu I am applying for a J-1 internship program at Oklahoma State University. I attest to the following I will return to the academic program at my institution in my home country to fulfill and obtain a degree after completion of this J-1 internship program at Oklahoma State University. I will be evaluated by my OSU internship supervisor at the end of the internship program* If the internship is longer than 6 months I will also be evaluated at the mid-point of the internship program* I understand that the internship program cannot last longer than 12 months in duration* I will have sufficient finances to cover my living expenses of myself and my dependents for the duration of my internship program* I will have medical insurance for myself and my dependents for the entire duration of my J-1 program in accordance with the requirements set up by the U*S* Department of State.

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