TRAINING/INTERNSHIP PLACEMENT PLAN

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Experience in Field (number of years)Program CategoryTrainee/Intern - I certify that: Annual RevenueTRAINING/ internship PLACEMENT PLANTrainee/Intern Name (Surname/Primary, Given Name(s) (must match passport name)SECTION 1: ADDITIONAL EXCHANGE VISITOR INFORMATIONE-mail Department of StateOccupational CategoryCurrent Field of Study/ProfessionType of Degree or CertificateDate Awarded (mm-dd-yyyy) or ExpectedTraining/ internship Dates (mm-dd-yyyy)FromToSECTION 2: HOST ORGANIZATION INFORMATIONOrganization NamePhase Site Address SuiteCityStateZIP CodeWebsite URLEmployer ID Number (EIN)Exchange Visitor Hours Per WeekCompensationYesNoIf yes, how much?per*OMB APPROVAL NO. 1405-0170EXPIRATION DATE: 05-31-2024ESTIMATED BURDEN: hoursWorkers' Compensation PolicyYesNoIf yes, Name of CarrierDoes your Workers' Compensation policy cover exchange Visitors?YesNo, exemptNumber of FT Employees Onsite at Location$0 to $3 Million$3 Million to $10 Million$10 Million to $25 Million$25 Million or MoreDS-700212-2020Page 1 of 5Printed Name of Trainee/InternDate (mm-dd-yyyy)Signature of Trainee/InternSECTION 3: CERTIFICATIONSProgram SponsorNon-Monetary CompensationNo, but equivalent have reviewed, understand, and will follow this TRAINING/INTERNSHIP PLACEMENT plan (T/IPP);2.)

Worker Protection Act, as amended (29 U.S.C. 1801 et seq.). f. I will notify the Department of State if I receive information regarding a serious problem or controversy involving the Trainee or Intern named in this T/IPP that could be expected to bring the Department of State, the Exchange Visitor Program, or the Sponsor's exchange visitor program

  Training, Plan, Internship, Worker, Placement, Training internship placement plan