GENERAL FORMS DESCRIPTION WHO MUST COMPLETE
______________________________ ________________________________________ ______________________________
  • P39 Recharge Form – Visa and Licensing Office
  • Recharge Forms (formerly P39) All departments requesting services from the DGSOM Visa and Licensing Office.
  • DGSOM Visa and Licensing Fee Structure
  • Summary of the Recharge Fee for Visa and Licensing Office Department Coordinators
    These are the most current fees for Visa and Licensing Services.
    H-1B Temporary Specialty Occupation Worker DESCRIPTION WHO MUST COMPLETE
    ______________________________ ________________________________________ ______________________________
  • Request for H-1B Sponsorship
  • For initial, extension, and amendment requests for Specialty Occupation Workers that are submitted to DCISS. Department Coordinators
    The department coordinators must initiate an H-1B Action in VITS for records and reports keeping and must send this form to Joan Cerera.
    O-1 Extraordinary Ability DESCRIPTION WHO MUST COMPLETE
    ______________________________ ________________________________________ ______________________________
  • O-1 Request for Eligibility Review
  • For initial O-1 Application. This form is used to request DGSOM Visa and Licensing Office and the Outside Counsel to review a prospective or current UCLA employee’s eligibility for O-1 Extraordinary Ability. Department Coordinators
    Please complete and email to JCerera@mednet.ucla.edu together with a copy of the Foreign National’s most recent CV.
    Do not include recharge form (P39).
  • O-1 Department Sponsorship Request Form
  • This form is used to request for the DGSOM Visa and Licensing Office to file an O-1 petition for a prospective or current employee at UCLA. Department Coordinators
    Once the O-1 eligibility determination has been conferred by the Visa Office Assistant Director, the department coordinators must initiate an O-1 Action in VITS for records and reports keeping and must send this form to Joan Cerera together with the required documents and the Visa Office Recharge Form.
  • Letter of Request for O-1 Sponsorship
  • Letter Template from the Department Chair justifying the need to fill the position and how the Foreign National will benefit UCLA. Department Coordinator signed by the Department Chair
    This letter must be submitted together with the O-1 Department Sponsorship Request Form
    Permanent Residence DESCRIPTION WHO MUST COMPLETE
    ______________________________ ________________________________________ ______________________________
  • PR Request for Eligibility Review
  • For PR Sponsorship. This form is used to request DGSOM Visa and Licensing Office and the Outside Counsel to review a prospective or current UCLA employee’s eligibility for PR sponsorship. Department Coordinators
    Please complete and email to JCerera@mednet.ucla.edu together with a copy of the Foreign National’s most recent CV.
    Do not include recharge form (P39).
  • PR Department Sponsorship Request Form
  • This form is used to request for the DGSOM Visa and Licensing Office to file a PR Sponsorship for a prospective or current employee at UCLA. Department Coordinators
    Once the PR eligibility determination has been conferred by the Visa Office Assistant Director, the department coordinators must initiate a PR Action in VITS for records and reports keeping and must send this form to Joan Cerera together with the required documents and the Visa Office Recharge Form.
  • Letter of Request for PR Sponsorship
  • Letter Template from the Department Chair justifying the need to fill the position and how the Foreign National will benefit UCLA. Department Coordinator signed by the Department Chair
    This letter must be submitted together with the PR Department Sponsorship Request Form.
    2111 DESCRIPTION WHO MUST COMPLETE
    ______________________________ ________________________________________ ______________________________
  • 2111 and 2113 Initial Application Request
  • This form is used to request 2111 or 2113 Special Programs License for Foreign M.D. Department Coordinators
    The department coordinators must initiate a 2111/2113 Action in VITS for records and reports keeping and must send this form to Joan Cerera together with the MBC Forms and other required documents plus Visa Office Recharge Form.
  • 2111 and 2113 Renewal Application Request
  • This form is used to request the renewal of 2111 or 2113 Special Programs License for a Foreign M.D. Department Coordinators
    This letter must be submitted together with the 2111/2113 Renewal Application.
  • 2111 Department Letter to Request Dean’s Office Support
  • Letter Template from the Department Chair requesting the DGSOM Dean’s Office support of the Appointment pursuant to Section 2111. Department Coordinator signed by the Department Chair
    This letter must be submitted directly to Joan Cerera together with the following:
  • Initial/Extension Application Request
  • MBC 2111/2113 Application
  • Required Documents
  • Recharge Fee (P39)
  • for the Vice Dean of Faculty approval and signature
    2113 DESCRIPTION WHO MUST COMPLETE
    ______________________________ ________________________________________ ______________________________
  • 2111 and 2113 Initial Application Request
  • This form is used to request 2111 or 2113 Special Programs License for Foreign M.D. Department Coordinators
    The department coordinators must initiate a 2111/2113 Action in VITS for records and reports keeping and must send this form to Joan Cerera together with the MBC Forms and other required documents plus Visa Office Recharge Form.
  • 2111 and 2113 Renewal Application Request
  • This form is used to request the renewal of 2111 or 2113 Special Programs License for a Foreign M.D. Department Coordinator signed by the Department Chair
    This letter must be submitted together with the 2111/2113 Renewal Application.
  • 2113 Department Letter to Request Dean’s Office Support
  • Letter Template from the Department Chair requesting the DGSOM Dean’s Office support of the Appointment pursuant to Section 2113. Department Coordinator signed by the Department Chair
    This letter must be submitted directly to Joan Cerera together with the following:
  • Initial/Extension Application Request
  • MBC 2111/2113 Application
  • Required Documents
  • Recharge Fee (P39)
  • for the Vice Dean of Faculty approval and signature
    MBC Letters DESCRIPTION
    ______________________________ ______________________________________________________________________
  • Physicians and Surgeons Certification for 2113 Service
  • Letter Template indicating the completion 36 months clinical services, pursuant to Section 2113.
  • 2060 Exemption Request Letter
  •