J-1 AT Evaluation Report Form

Last Name

Given Name

Date of Birth

SEVIS ID#

Current US Address (Including Street number, street name, city, state and postal code)

Telephone Number

Email Address

Academic Training (AT) Detail

Employer Name

AT Start Date

AT End Date

How effective was your J-1 Academic Training in meeting the goals/objectives for this specific training program?

Please explain and give examples why you selected the rating above

How would you rate the overall quality of the J-1 Academic Training experience?

Please explain and give examples why you selected the rating above

Additional comments

I confirm that the statements above are accurate and true. (Type your name in box to indicate signature of confirmation)