"*" indicates required fields Personal Information First Name* Last Name* Email* U.S. Housing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Please answer the following questions. This form will allow Greenheart Exchange to better understand your situation and your reasons for wanting to change your Host Organization Why do you want to change Host Organizations?*Have you found a new Host Organization to inter/train with?* Yes No Host Organization Name* Host Organization Physical Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Host Organization Contact Name* If you have found a new Host Organization to work with, will they offer training specific to your academic and career goals?* Yes No Please provide any additional information as to why this change of Host Company will benefit you as an intern or traineeTerms and Conditions:* I understand that the decision to approve or deny my request to change host organizations is at sole the discretion of Greenheart Exchange, my J-1 visa sponsor. I understand that I must obtain permission from Greenheart Exchange to change host organizations during my J‐1 Intern/J-1 Trainee program. I understand that I am responsible for proper submission of all required documents by the deadlines and in the manner required by Greenheart Exchange in order for Greenheart Exchange to review my request to change my host organization. I understand that leaving my current approved host organization without prior approval from Greenheart Exchange could result in my J-1 visa sponsorship being terminated. I understand that I must receive explicit written approval from Greenheart Exchange before I may begin training at a new host organization. I understand that beginning training at a location not approved by Greenheart Exchange could result in my visa sponsorship being terminated. I understand that that if my request to change of host organizations is approved, I will be subject to all applicable fees. I agree
