INSTRUCTIONS FOR NEW APPLICATION
5. Select appropriate categories prior to filling out this data. (See 22 CFR 62 .2 CFR 62 .4 and 22
6-10. Complete information on program and program sponsor.
IF TRAINING PROGRAM, identify appropriate fields and specialties/non-specialities: 01-Arts & Culture; 02-Information
Media and Communications; 03-Education, Social Sciences, Library Science, Counseling and Social Services;
04-Management, Business, Commerce and Finance; 05-Health Related Occupations; 06-Aviation; 07-The Sciences,
Engineering, Architecture, Mathematics and, Industrial Occupations; 08-Construction and Building Trades;
09-Agriculture, Forestry and Fishing; 10-Public Administration and Law; 11-Other (Specify).
11-12. Certification. Citizenship for new applicants requires certification below.
CITIZENSHIP (22 CFR 62.2 and 5)
I hereby certify that I am an officer of this program with the title of
that I am authorized to sign this certification and bind
(b) Responsible Officer or Alternate Responsible Officer
DS-3036 (Formerly IAP-37)
DOS USE ONLY
Type of Program:
Subtype if applicable:
No. Forms DS-2019: (Formerly IAP-66)
Subscribed and sworn to before me this
Signed in ink (Name):
PLEASE RETURN FORM TO:
Page 1 of 3
(name of organization); and that a true copy certified by the
(specify) of such
authorization is attached. I further certify that
(name of organization) is a citizen of the UnitedStates as that term is defined at 22 CFR 62.2
(Name of organization) agrees that its inability
to substantiate its representation of citizenship made in this certification will result in the immediate withdrawal of its
designation and the immediate return of or accounting for all DS-2019 forms transferred to it.
Office of Exchange Coordination and Designation
Bureau of Educational and Cultural Affairs
U.S. Department of State, SA-44 Room 734