| Completed applicant information sheet |
| U.S. Dept. of State J-1 waiver file number (if applied for) |
| Signed J-1 Affidavit and Agreement Form |
| Notarized Dept. of State Exchange Visitor Attestation Form |
| Personal statement providing (a) the reasons for not wanting to fulfill the 2-year home residency
requirement, (b) reasons for practicing in this specific field of medicine, (c) how your expertise could
impact the patients in this locality, and (d) specific reasons for accepting the employment contract
offered by the University of Mississippi Medical Center |
| Provide photocopies of the following: |
| Medical school degree/diploma |
| Residency/Fellowship certificates |
| Evidence of completion of Steps 1, 2, and 3 of the U.S. Medical Licensing Examination |
| ECFMG certificate |
| Curriculum Vitae |
| Social Security Card |
| All pages of passport* |
| Copy of Form I-94* |
| All receipts and approval notices from USCIS* |
| All copies of Form DS-2019 issued while participating in "J" status* |
| Medical license |
| Check for $3,000 made payable to the Delta Regional Authority to cover J-1 waiver application fee
(Please do not submit until requested) |
| *Include copies of documents of spouse and children if applicable |