Application For Victor Manuel Avellaneda Gomez Page 1 of 11

User avatar Victor Manuel Avellaneda

Gomez
SWT 2024 Colombia
WISE ID: WT240642

Participant Info
Last Name Avellaneda Gomez

First and Middle Name Victor Manuel

Date of birth 04 May 2002

Ag e 21 years old

Gender Male

Email victoravellaneda45@hotmail.com

Phone +57 3157925357

Skype

Address Colseguros norte, Bucaramanga, Santander, 680001,

Colombia

Country of Leg al Residence Colombia

Citizenship Colombia

Birth City Bucaramanga

Ag ency Name SEP Colombia Group S.A.S.

Prog ram Start Date

Prog ram End Date

Emergency Contact Details

Emerg ency contact name Victor

Emerg ency contact number 3002443124

Emerg ency contact relationship Friend

Emerg ency contact email vcoade-kun@outlook.es

Previous J1
We would like to know if you have completed a J1 program before.
Application For Victor Manuel Avellaneda Gomez Page 2 of 11
Have you previously participated on a J- 1 visa No
prog ram in the United States?

Previous J1
Application For Victor Manuel Avellaneda Gomez Page 3 of 11

Education
Education
Please complete your education information below.

Are you currently enrolled as a f ull time University Yes

student?

Please enter the name of the University Universidad industrial de santander

Field of Study: Mathematics

You are in the: Undergraduate Program (215)

Date you are able to beg in your prog ram: 01 May 2024

Last available date f or your prog ram: 30 August 2024

Application For Victor Manuel Avellaneda Gomez Page 4 of 11

Work and Travel Agreement

Work and Travel Agreement
It is very important that you read and understand these rules. If you have any questions please ask WISE bef ore
you sig n
this ag reement.

Pre-Arrival

I understand and agree that the purpose of this program is cultural exchange. I do not expect to earn more money than
to cover the cost of my basic needs while in the United States (U.S.) such as food, public transportation, and housing. I do
not expect to be able to save money to take home.
I understand I will probably not earn enough money to pay for my program costs. I do understand and expect that I will
make a basic wage in accordance with State and Federal Labor laws, but that this amount is not expected to be much
more than my living expenses.
I will arrive to the U.S. with enough money to cover food, housing cost, transportation, deposits, etc. (at least $1000), and
I understand that it may be 4 weeks before I receive my first paycheck.
I must log into my WISE online account at least once a week beginning at the time of my application until the completion
of my program to ensure I’m receiving all necessary information and required communications to assist in my successful
completion of the program.
I must read and respond, if necessary, to all documentation from WISE and the overseas agency before I go to the U.S.,
including this agreement, the WISE Participant Manual, the pre-departure orientation information presented to me by my
agency, and all Pre-Arrival Orientations sent to me from WISE. I will ask for explanation of any part that I have questions
about before I go to the U.S.
I understand and agree that I am required to complete 3 online Pre-Arrival Communications/Orientations PRIOR to the
issuing of my DS-2019 form. Failure to complete these 3 online communications/orientations will result in WISE removing
me from consideration for program participation. If this happens, I will not be able to participate on the program and no
refund of paid fees will be issued
I understand and agree that WISE has offered me the ability to purchase Travel Cancelation and Travel Interruption
Insurance. If I purchase this insurance and am unable to participate on the program, I will receive a refund of program
fees and other covered fees per the insurance policy. My refund of benefits will come from the insurance company and
not from WISE. If I choose not to purchase the Travel Cancelation and Travel Interruption Insurance, I may lose a portion
of or all of the paid program fees. I will review the Travel Cancelation and Travel Interruption Insurance Policy carefully
and, if necessary, ask my agency or WISE questions for clarification before deciding whether or not I will purchase this
insurance. This is to ensure I am making a fully informed decision on this matter
I understand and agree that I am over 18 years of age, which, in the U.S., makes me an adult. This means that I will be
held responsible for the forms that I sign. It is my responsibility to make sure that I understand everything I am signing, as
WISE will hold me to this agreement.

Communication

I must check my email address and/or log into my WISE online account every week to ensure I’m answering all required
communications and to receive assistance and guidance from WISE on addressing any issues and having a successful
program. I must answer these emails and communicate with WISE on time. I have to give WISE a phone number where I
can be reached though out the duration of my program.
I have to validate my visa within 72 hours of arriving to my employer. This means that I must contact WISE and give them
my living address and cell phone number.
Within 7 days of my validation, I will receive a Post-Arrival Orientation. Completing this orientation is required to continue
in my program.
I have to communicate with WISE every month through the surveys that WISE sends to me via email and in my online WISE
account for completion. Incomplete answers will not be accepted.
I understand this is a cultural exchange program and I will use the information and advice that WISE gives me to
participate in cultural exchange activities while in the U.S.
If issues arise while in the U.S., my first point of contact is the WISE Foundation.
Application For Victor Manuel Avellaneda Gomez Page 5 of 11

Work

I agree to follow the rules and expectations of my employer. I have to obey reasonable request by the employer to stop
wrong behavior to ensure all rules and expectations are followed,
I agree to follow all health and safety policies put in place by my employer and local, state, and federal authorities. I
understand that my employer will do everything possible to maintain healthy work and living environments, but that I may
work and live in close physical proximity with other individuals.
I understand that there are certain jobs in which I may not work. If WISE tells me that I cannot work in a certain job, I agree
not to do so.
I am aware that I am not guaranteed the option of overtime. I will refer to the job offer for additional details on working
hours.
I cannot change or quit jobs without first getting permission from WISE. I understand that I will be responsible for finding
a new job for myself in the time that WISE will give me. I cannot begin working in the new job until WISE gives me
permission. I understand that if I begin working in a job without first giving WISE the vetting documents and getting WISE’s
permission, or if I do not send the information and required documents to WISE by the time WISE will give me, I will be
breaking the rules of the WISE Work & Travel Program, which might mean that I lose my program sponsorship.
I can begin working at a 2nd job while on the program only after informing WISE, receiving permission from WISE, and
completing the vetting documents.
I understand that WISE expects me to work until the last day stated on my DS-2109 form. If I need to leave my job early, I
must contact WISE first to discuss the situation with them, and only with WISE’s permission (which includes getting
permission from the employer) may I take steps to leave early. I also understand that I may lose housing deposit refunds,
etc. in employer-provided housing according to the housing contract that I signed with the employer.
If I want to leave my current job to work for a new employer or to end the work portion of the program to begin
traveling, I must give my current employer two weeks’ notice of my last day of work unless WISE tells me otherwise.
I understand that my sponsor will do their best to assist me should I lose my employment to a natural disaster, pandemic
or business interruption from my host employer while in the U.S. but realize they cannot guarantee that another
placement will be found for me.
I understand that I will have 2 weeks to find a new program-compliant job should local, state, or federal health orders
interrupt my employment. If I am unable to find a job within this time, I understand that I may need to return home. I also
understand that I will be responsible for my own expenses during this period to include rent payments, food, or any other
necessities I may require.

Housing

I understand that rent and housing deposit will be payable per my job offer and housing agreement. If I have concerns
about my housing, I will contact WISE.
If I do not bring the required money including housing deposit, rent, and money to cover my living expenses until I receive
my first paycheck, I may need to end my program and return home.
I must respect the property of others, including the Work & Travel site and the housing facilities. Damaging and/or
stealing property can cause eviction and/or disciplinary action.
I must follow all housing rules that I sign and agree to in my housing contracts.
I understand that all housing must be approved by WISE in advance. If I decide to change housing during the program, I
must submit to WISE the address, pictures (inside and out) and any further requested information to WISE for their
approval prior to moving to new housing.
If WISE deems that I may not live in a particular housing location, I must not live there and must follow their instructions
and guidance to ensure I am living in housing that is acceptable to the standards of the program.

Visa Requirements

I must arrive to my employer on the DS-2019 start date for work, and if I do not communicate with WISE about why I am
not at my employer, WISE will have to change my program status to “NO SHOW” in SEVIS which could affect future visits
to the U.S.
I will obey all local, state and federal laws. I understand that WISE has the right to terminate a participant's program if the
participant's behavior or actions are thought to be dangerous to themselves, the Work & Travel employer, or the public
at large. The participant will return to his/her home country at his/her own expense within 7 days.
I have a maximum travel time of 30 days after my program has ended. I understand that the local U.S. Embassy and
official university summer holiday dates may shorten my maximum travel time. I have discussed my dates with my local
agency.
I understand that my J-1 visa cannot be extended. I declare that I have no intention of staying in the U.S. after the final
date allowed by this program.
Application For Victor Manuel Avellaneda Gomez Page 6 of 11
If any dispute should arise out of my relationship with WISE, I understand that is will be governed by the laws of
Tennessee and Madison County Circuit Court will have sole jurisdiction. The prevailing party will be entitled to all costs
including, but not limited to, reasonable attorneys’ fees.
In sig ning this ag reement, I acknowledg e that I have read, understood, and ag ree to all the terms and
conditions of my own f ree will stated above. Ag ain, please remember: even if you don’t read these rules, you
still have to f ollow them!

Sig ned by: Victor Manuel Avellaneda

Application For Victor Manuel Avellaneda Gomez Page 7 of 11

Medical Form
Medical Form
We need to know some of your medical history to make sure you are covered.

Have you ever been hospitalised? No

Are you currently taking any medication or No

injections?

I will bring enoug h medication to cover my medical I am not currently taking any medication or injections
needs f or the entire leng th of the prog ram:

Do you presently have any diag nosed condition No

requiring ong oing treatment or check- ups?

Do you have and additional pre- exisiting medical No

conditions?

Will you have any issues working in a physically No

demanding job?

Please rate your physical condition: Good

I ag ree that the above inf ormation is accurate. I agree

Application For Victor Manuel Avellaneda Gomez Page 8 of 11

Liability Release Statement

Liability Release Statement
The undersigned, as a participant in a program organized and directed by The Foundation for Worldwide International
Student Exchange, hereafter referred to as WISE, on behalf of ourselves, your sponsor, and our successors or legal
representatives renounce any claim against WISE, its employees, directors or officers, agents, coordinators and host site
where the participant may be assigned, or any person interviewing in the program, that may arise due to injury, damage,
sickness, accident, delay, unusual government restrictions, or regulations, or those derived from acts of omission of airlines,
shipping companies, railroads, busses, transportation in general, hotels, restaurants or any other service given by
companies, individuals or anyone related with the aforementioned.

I understand that, as a participant, I will be subject to the authority of WISE and must follow the rules provided by the
program and host site. I also understand that WISE reserves the right to terminate sponsorship in the program of any
participant whose conduct during the program period may be considered detrimental or incompatible with the interest and
security of the program. If this decision is ever taken, the participant will have no right to any refunds.

I accept the right of WISE to directly or indirectly cancel, change, or substitute in emergencies or whenever normal
circumstances change, those elements of the program whose alteration is deemed necessary by WISE. I understand that
should there be a geographic move of the participant for any reason whatsoever, the cost of the transportation shall be
borne by the participant.

I grant WISE permission to use in the future any photographic or any other type of material in which I, the participant may
appear for promotion or publicity of the organization's programs.

I grant WISE, at its discretion, and if necessary, at the cost of the participant, or his/her parents, in the case of expenses
exceeding the coverage of the insurance policy covering the participant the power to place him/her in a hospital or in any
other institution for any type of assistance or medical treatment or, if there is no hospital available to place him/her under
the case of the medical doctor of WISE's choosing for his/her treatment.

I grant WISE authority to act as my representative while in the United States including, but not limited to, all necessary
functions to act as legal guardians in loco parentis in any situation, especially in emergencies whether medical or other,
including the possibility of permission for surgical operations or other medical or mental treatment. WISE shall be the only
agency to authorize any medical or mental treatment of participant.

I authorize WISE to return me to my home country of origin at my cost, if necessary, to submit to medical treatment, if this is
deemed necessary by the above-mentioned people, after consultation with medical authorities. I confirm that at the time of
signing this document that I enjoy satisfactory physical and mental health, that my health record enclosed herewith is true
and complete, and that I may engage in any physical or sport activity unless so noted in the Medical Statement or Medical
Insurer's policy.

I grant WISE permission to act on my behalf in anything pertaining to possible representation before the local authorities.
This authorization shall be valid the entire duration of the WISE program in which I am participating.

Sig ned by: Victor Manuel Avellaneda

Application For Victor Manuel Avellaneda Gomez Page 9 of 11

Elective Insurance Coverage

Optional Automobile Operator Insurance
Please read the following statement carefully, either accept or decline coverage below:
· I understand that the insurance company arranged for me by WISE or its representatives offers an optional
medical insurance coverage that will provide benefits for any injuries caused by an accident which happens while
I am operating a private passenger automobile.
· I understand that this extended coverage is optional and I must enroll while supporting paperwork for the J-1
visa is being issued.
· If I accept coverage, I understand that there will be an additional $20.00 added to my WISE
insurance premium (if applicable).
· If I accept coverage, I understand that coverage will be rescinded and all claims denied, if I am not legally
licensed or insured to operate a private passenger automobile in the U.S. state where I am assigned. All standard
policy terms and conditions apply. I understand that this insurance does not include coverage for the operation of
motorcycles, scooters, golf carts, planes, helicopters, jet skis, boats or other recreational vehicles.

Do you accept or decline the optional automobile I decline the optional automobile operator insurance (You
insurance coverag e? will still be covered under your medical insurance policy.)

Optional Non-Motorized Winter Sports Insurance

Please read the following statement carefully, either accept or decline coverage and sign below: Your signature below is
REQUIRED whether you are accepting or declining coverage.

· I understand that the insurance company arranged for me by WISE or its representatives offers an optional medical
insurance coverage that will provide benefits for any injuries caused by an accident which happens while I am skiing,
snowboarding, and tubing.

· I understand that this extended coverage is optional and I must enroll while supporting paperwork for the J-1 visa is being
issued.

· If I accept coverage, I understand that there will be an additional $80.00 added to my WISE insurance premium (if
applicable).

· If I accept coverage, I understand that coverage will be rescinded and all claims denied, if I am not wearing proper safety
equipment, not skiing within resort border, or taking part in activity, under the influence of alcohol or drugs. I understand that
this insurance does not include coverage for the operation of any winter recreational vehicles; racing; bobsleighing/
bobsledding; luge; skeleton; freestyle skiing; freestyle snowboarding skijoring; any form of power-assisted skiing,
snowboarding, or tubing; snow kiting; snow biking; snow rafting; ice hockey; ice climbing; and activities on frozen lakes and
rivers. All standard policy terms and conditions apply.

Do you accept or decline the optional non- motorized I decline the non-motorized winter sports insurance (You will
winter sports insurance? still be covered under your medical insurance policy)

Optional Trip Interruption/Trip Cancellation Insurance

Please read the following statement carefully, and either accept or decline coverage by signing below. Your signature below
is REQUIRED whether you are accepting or declining coverage.

· I understand that the insurance company arranged for me by WISE or its representatives offers an optional trip interruption
insurance policy that will reimburse me for the lost portion of my trip, as well as any additional expenses for a last-minute
flight home, if I am required to return home due to a covered reason.

· I understand that the insurance company arranged for me by WISE or its representatives offers an optional trip cancellation
insurance policy that will reimburse me for the amount of pre-paid, non-refundable travel expenses that are insured in the
policy, should I cancel my program before departure for an unforeseen covered reason.

· I understand that this coverage is optional and I must enroll while supporting paperwork for the J-1 visa is being issued.

· If I accept coverage, I understand that there will be an additional $100.00 added to my WISE insurance premium (if
applicable).
Application For Victor Manuel Avellaneda Gomez Page 10 of 11
· If I accept coverage, I understand that this insurance does not include coverage for non-covered reasons.

· If I decline coverage, I understand that I will not receive a reimbursement for the lost portion of my trip and/or expenses
related to a last-minute flight home, no matter the reason for the trip interruption.

· If I decline coverage, I understand that I will not receive a reimbursement for the amount of pre-paid, non-refundable travel
expenses should I cancel my program before departure, no matter the reason for the trip cancellation other than those
outlined in my prog ram cancellation f ee ag reement with my ag ency

Do you accept or decline the optional trip interruption I decline the optional trip interruption insurance. (You will still
insurance? be covered under your medical insurance policy.)
Application For Victor Manuel Avellaneda Gomez Page 11 of 11

Resources Agreement
Resources Agreement
The WISE Foundation provides you with detailed and important information to help you have a successful experience in the
US.

These items are provided online in the RESOURCES section of your WISE account.

As you progress through the application process - while arranging your travel to the US and throughout your entire J-1
Program, the information provided to you in the RESOURCES section of the WISE database are updated at each application
stage change.

You are responsible f or caref ully reading and being f amiliar with this inf ormation.

Examples of important resources you will find once your application process is complete include:

How to prepare for your consulate interview

What to do upon arrival to start your program
Medical insurance details
Documentation to apply for your Social Security number
Many additional items to help you succeed on your program

By signing below, you acknowledge that you are aware of the RESOURCES section, understand that it will update throughout
your program, and agree to carefully review all the information presented.

Sig ned by Victor Manuel Avellaneda