Text Go
Greenheart Exchange Work and Travel Program
Program Fees Transparency Acknowledgement (PFTA)
The purpose of this document is for the sending partner to disclose all non-refundable program fees that are charged to Work and Travel Program
participants. The sending partner should complete only one column depending on the program option. Each participant must review and sign the
following agreement prior to paying any non-refundable fee. The sending partner confirms that all non-refundable fees are disclosed below and
have been explained to the participant.
Participant Name: Greenheart Exchange ID:
Full Placement Option (placement arranged by Self-Placed Option (placement arranged by
Fee Type
Sponsor) Participant or Sending Partner)
Local currency: 130232 Local currency:
Total Program Fee:
USD: 2355 USD:
Does the total program fee include the following? Check YES/NO.
If you check NO for an item, you MUST include the USD fee in the yellow field.
Sponsor Fee YES NO $_______ YES NO $_______
Interview/Screening Fee YES NO $_______ YES NO $_______
English Eligibility Test YES NO $_______ YES NO $_______
Translation of School Documents YES NO $_______ YES NO $_______
Health Insurance for Work Period YES NO $_______ YES NO $_______
Health Insurance for Travel Period YES NO 35
$_______ YES NO $_______
Expedited Processing YES NO $_______ YES NO $_______
Pre-Departure Orientation YES NO $_______ YES NO $_______
Employer Interview Training YES NO $_______ YES NO $_______
Visa Interview Training YES NO $_______ YES NO $_______
Job Offer YES NO $_______ YES NO $_______
Flight to United States YES NO 650
$_______ YES NO $_______
SEVIS Fee YES NO $_______ YES NO $_______
Cancelation Fees (General sponsor cancelation policy: Cancelation fee can be from 50 USD up to entire program fee, depending on the time
of placement or program cancellation)
Local Currency: 2715 Local Currency:
Sponsor Cancelation Fee
USD: 50 up to program fee total USD:
Local Currency: 2715 Local Currency:
Partner Cancelation Fee
USD: 50 up to program fee total USD:
Additional Fees (List type of fee. Examples: missing flight and visa fee, enrollment fee, visa fee, application fee, courier fee, SEVIS fee, flight
booking fee, travel insurance, orientation in the U.S., DS-2019 reprint fee, program/insurance extension fee, other, etc.)
Additional fee: 20 USD fee for Local Currency: 1106 Local Currency:
missing visa information 3 weeks
prior to program start date USD: 20 USD:
Additional fee: 20 USD fee for Local Currency: 1106 Local Currency:
missing or incorrect flight information
2 weeks prior to program start date USD: 20 USD:
Local Currency: 8958 Local Currency:
Additional fee: visa appoimnet
USD: 162 USD:
Local Currency: Local Currency:
Additional fee:
USD: USD:
Local Currency: Local Currency:
Additional fee:
USD: USD:
As a participant on the Greenheart Exchange Work and Travel program, I agree to the fee schedule listed above. I confirm that all
applicable program fees have been explained to me prior to making any non-refundable payment. I will review my job offer for
information about additional fees I may be charged by my host organization.
Participant Signature (handwritten):
Date signed (mm/dd/yy):
Participant Name (printed):
