J-1 scholars are permitted to participate only in the research or teaching activity listed on the DS-2019, at the location listed on that document. With prior approval from DARI, however, scholars may also participate in occasional lectures or consultations and similar activities, and receive payment for those activities. Complete this form to request such authorization for an “outside” payment. Upon approval, the authorization will be recorded in your DARI and SEVIS records, and DARI will issue a payment authorization letter for you to provide to the inviting institution. You will be notified by e-mail when the letter is available for pick-up. Your request will not be processed until we receive the completed form!

Section A:	To be completed by the J-1 scholar or UPR host department.

Name:

Surname	Given Name	Middle Name

SEVIS ID number:	E-mail:

Section B:	To be completed by the inviting institution.

Name of Institution:

Description of activity (including field or subject):

Dates of activity: to Number of hours being compensated:

Full address of activity (including zip code):

Type and amount of compensation:

Name of Contact Person: E-mail:

Signature: Date:

Section C:	To be completed by the UPR faculty host or department head.

I certify that the activity described above is incidental and directly related to the J-1 scholar’s University of Puerto Rico program objective(s) and will not delay the completion of the program. Further, I recommend this activity, as it enhances the scholar’s J-1 program in the following way:

Name of Faculty Host:

Signature: Date:

Rev. Dec., 2016