EXCHANGE VISITOR: PROOF OF STUDENT STATUS

Exchange Visitor Last Name(s): Santander Romero

Exchange Visitor Given Name: Johan Alonso

Date of Birth (mm/dd/yyyy): 04/17/1999

Email Address: joalsanro@hotmail.es

Home Country Agency Name: SEP COLOMBIA GROUP

SECTION 1 – UNIVERSITY INFORMATION – must be completed in full

Full Name of University: Universidad Industrial de Santander

University Address: Carrera 27 calle 9 (Bucaramanga-Colombia)

Official Break Start: 05/05/2024 Official Break End: 09/04/2024

Major field of study: Electric Total years completed: 3

Engineering
Professor - Reference Name: Luis Carlos Mantilla Espinosa

Professor - Reference Email: luis.mantilla@e3t.uis.edu.co

SECTION 2 – EXCHANGE VISITOR INFORMATION – must be completed in full

# of previous J exchanges: 1 Program type(s): Work and Travel

Requested DS-2019 Start Date: 05/10/2024 Requested DS 2019 End Date: 08/30/2024

Notes on availability: NA

SECTION 3 – VERIFICATION
To complete your eligibility form please attach the following. Your form is considered incomplete until received.
o University Transcript or University course verification page
o Certified translation of Transcript or course verification in English

I hereby certify that all of the above information is truthful, accurate, and can be verified with additional
documentation should any be requested. If at any point my university status changes, I will notify my home
country agency and United Work and Travel immediately. I recognize my eligibility in the BridgeUSA Work
Travel program is dependent upon my certified full time university status.

02 / 11 / 2024

Exchange Visitor Signature Date

Revised 7/18/2023 (for use in program year 2024)

Doc ID: 18c352c9d435bab6f04004ac9d4675b092fbf7f7

 2024: Exchange Visitor Student Status
Exchange Visitor ...Status (2024).pdf
18c352c9d435bab6f04004ac9d4675b092fbf7f7
MM / DD / YYYY
Signed

02 / 11 / 2024 Viewed by - (joalsanro@hotmail.es)

16:38:55 UTC IP: 181.131.227.221

02 / 11 / 2024 Signed by - (joalsanro@hotmail.es)

17:19:28 UTC IP: 181.131.227.221

02 / 11 / 2024 The document has been completed.

17:19:28 UTC