CAP Program Extension Request form

Personal information
- First Name*
- Last Name*
- Greenheart Exchange Online ID Number*
- Email Address*
Program & Date information
- Program Option*
- Name of Host Organization*
- Current DS Start Date*
  MM slash DD slash YYYY
- Current DS End Date*
  MM slash DD slash YYYY
- Requested New End Date*
  MM slash DD slash YYYY
Reason for request
- Why do you want to extend your program?*
- How would an extension benefit you intern/training program?*
- Conditions of Greenheart Exchange CAP Program Extension:*
  By checking this box and submitting my J-1 program extension request, I understand that granting of this request is contingent on approval from Greenheart Exchange and my current Greenheart Exchange-approved Host Organization. I also understand that the request for program extension applies only to my current position in my Host Organization named above. If my request is approved, I understand that I am responsible for paying all applicable fees (as detailed in the participant handbook), and that these fees are subject to change. I also understand that in order to receive final approval, I will be required to submit a new DS-7002 Training Plan outlining the details of the remainder of my training period.
  I agree