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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?per*OMB APPROVAL NO. 1405-0170 EXPIRATION DATE: 05-31-2024 ESTIMATED BURDEN: hoursWorkers' Compensation PolicyYesNoIf yes, Name of CarrierDoes your Workers' Compensation policy cover exchange Visitors?)

Each Training/Internship Placement Plan should cover a definite period of time and should consist of definite phases of training or tasks performed with a specific objective for each phase. The plan must also contain information on how the trainees/interns will accomplish those objectives (e.g. classes,

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