Section 591.120 Application Materials and Processing

a)         Application materials are available from, and should be returned to, the following address:

            J-1 Visa Waiver Program

            Illinois Department of Public Health

            Center for Rural Health

            535 West Jefferson Street

            Springfield, Illinois 62761

b)         The application materials to be prepared by or on behalf of the international medical graduate seeking the waiver of the two-year home-country residency requirement shall include the following items:

1)         statement from the administrator or director of the health care facility or agency that will be employing the international medical graduate describing prior recruitment difficulties experienced by the facility, the expected practice arrangement for the international medical graduate, and the impact on the facility and the patients it serves if the home country residency requirement is not waived;

2)         copy of a minimum three-year employment contract between the international medical graduate and a health care facility.  The contract shall include the name and address of the facility, the specific geographic area or areas in which the international medical graduate will practice, and a statement that the physician will practice full-time  (40 hours) in the HPSA, HPSAs, or MUA/P identified in the contract; or, if the facility is not located in a HPSA or MUA/P, documentation that at least 51% of the participating physician's patients come from a HPSA or MUA/P;

3)         statement from the employing health care facility or agency that the salary or other form of financial support offered to the international medical graduate is at a level equivalent to that offered to all other physicians with equivalent skills and experience recruited by the health care facility;

4)         letter of support from a hospital chief of staff  verifying that hospital admitting privileges will be granted to the international medical graduate, and if not, how admissions of the international medical graduate's patients will be arranged;

5)         letter of support for the visa requirements waiver from at least one local organization or agency such as the chamber of commerce, local health department, or other community-based organization;

6)         copy of the applicant's Illinois medical license or application for an Illinois medical license;

7)         completed United States Information Agency Data Sheet;

8)         copy of international medical graduate's curriculum vitae;

9)         copy of the IAP-66 (Certificate for Exchange Visitor J-1 Status) for each year international medical graduate was in J-1 status;

10)         completed and notarized Certification Statement A signed by the international medical graduate agreeing to the contractual requirements set forth in Section 214(l)(1)(B) and (C) of the Immigration and Nationality Act;

11)         completed and notarized Certification Statement B describing international medical graduate's obligation to his/her home country;

12)         completed and notarized Certification Statement C in which international medical graduate states that his or her medical license has never been suspended  or revoked and that he or she is not subject to any criminal investigation or proceedings by any medical licensing authority;

13)         completed and notarized Certification Statement D regarding accuracy of application materials; and

14)         completed and notarized Certification Statement E regarding specialty status.

c)         Upon receipt of the application materials, Center for Rural Health staff will verify completeness and accuracy of the application.  One written request to the applicant, or the facility or legal agency acting on behalf of the international medical graduate, will ask for any materials not included in the application.  If the requested materials are not received within one month after the date of the written request, the application will be returned to the applicant.

(Source:  Amended at 30 Ill. Reg. 898, effective January 5, 2006)