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TRAINING/INTERNSHIP PLACEMENT PLAN

Experience in Field (number of years)Program CategoryTrainee/Intern - I certify that: Annual RevenueTRAINING/ internship PLACEMENT PLANT rainee/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 INFORMATIONO rganization NamePhase Site Address SuiteCityStateZIP CodeWebsite URLE mployer ID Number (EIN)Exchange Visitor Hours Per WeekCompensationYesNoIf yes, how much?)

10. I certify that this training or internship meets all the requirements of the Fair Labor Standards Act, as amended (29 U.S.C. 201 et seq.), if applicable. I also certify that training or internships in the field of agriculture meet all requirements of the Migrant and Seasonal Agricultural Worker

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