DOH Forms
Additional Health Department Forms

Forms for J-1 Visa Waivers

Workforce Development
J-1 Visa Application
Form # Title PDF/WORD Instruction/ Comments
MCCH-1 J-1 Visa Waiver Physician-Primary Care Survey, Initial/Biannual Service Report pdf 15k
doc 68k
MCCH-5 J-1 Visa Waiver Application for New Jersey pdf 26k
doc 112k
MCCH-5A Attachment A: Current Medical Staffing at Practice Site pdf 11k
doc 42k
MCCH-5B Attachment B: Health Care Resources Inventory pdf 10k
doc 50k
MCCH-5C Attachment C: Facility Current Sliding Fee Scale pdf 7k
doc 19k
MCCH-5D Attachment D: J-1 Physician Visa Waiver Statements pdf 8k
doc 25k
MCCH-6 Section 4-1, Health Facility's J-1 Visa Waiver Agreement pdf 15k
doc 31k
MCCH-7 Section 4-2, Physician J-1 Visa Waiver Affidavit and Agreement pdf 16k
doc 32k
MCCH-8 Section 5, J-1 Visa Waiver Required Application Enclosures pdf 9k
doc 20k
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