J-1 Physician Letter Template

It is a requirement for individuals visiting Penn on a J-1 visa, who hold MD (or equivalent) degrees, to provide a letter, signed by the Dean's designee and the chair of the appointing department, which affirms the visitor's duties at Penn will involve zero or incidental patient contact.

To submit a letter request, please complete the below form with the relevant details and, once the department chair's signature has been applied, email the signed letter to the Office of the Dean for CSO approval.

Form Instructions

Ensure that the Exchange Visitor’s name precisely matches their visa documentation. Do not use nicknames, abbreviations, or alternative spellings.
The Department Chair must sign the form before the CSO in the Department Chair signature area. A visible electronic signature, scanned signature image, or Adobe Fill & Sign signature is acceptable.
Email the signed letter to the Office of the Dean for CSO for approval after the Department Chair has signed.
If approved, the Office of the Dean will add the CSO signature and return the fully executed copy.