HTML Preview Internal Department Transfer Letter Format page number 1.
Medical Institutions: Reed Hall, Suite 405,1620 McElderry Street, Baltimore, MD 21205: 410-955-3371
12/03/2013
J-1 Inter-Department Transfer
You must complete this form if you will be transferring between departments within School of Medicine, School of Public Health
or School of Nursing. All fields and signatures are required. It is the J-1 Exchange Visitor's (EV) responsibility to get the
signatures from your current department as well as the department you will transfer to. *Incomplete requests will not be
processed.
New Department:
Current Department:
E-mail Address:
SEVIS #: N Date of Birth:
SECTION 1: Must be Completed by the J-1 Exchange Visitor:
Expected Start Date in New Department:
Expected End Date in Current Department:
*By signing below, I confirm that I have given notice to my current department of my intent to transfer. I also understand that I
must continue to work in my current department until my DS-2019 is amended by the OIS and/or the effective start date for new
appointment has reached. Failure to do so may affect my legal J-1 status.
Date:Signature of J-1 Exchange Visitor:
SECTION 2: Must be Completed by the Current Department:
*By signing below, I confirm that the aforementioned J-1 EV has informed the department of his/her intent to transfer to a
different department.
Date:Signature & Name of Preceptor/Advisor:
Date:Signature & Name of Dept. Administrator:
Department:
End Date of Appointment:
SECTION 3: Must be Completed by the New Department:
*By signing below, I confirm that the aforementioned J-1 EV has been offered an appointment in my department and may begin
his/her appointment only after the changes are made to the EV's SEVIS record by the OIS. I also confirm that the J-1 EV will
continue his/her original research objective during this transfer.
NOTE: The hiring preceptor is required to provide a letter verifying that the EV's original research objective will remain the same
during this transfer. The letter must contain a brief description of the original and the new research and the relationship between
both. The department must submit this form and letter along with J-1 Amendment Request to the OIS.
Date:
Date:
SIgnature & Name of Preceptor/Advisor:
Signaure & Name of Dept. Administrator:
Department:
Start Date of Appointment:
Last Name: First Name: