The Parker J-1 Hardship Waiver Assessment

2. Which best describes your home Country?

Europe

Middle East

Other

3. How would you best describe how friendly your home country is with the U.S.?

Very Friendly

Somewhat Friendly

Not Friendly

4. What is the general health of the members of your family?

Everyone is healthy

My child or spouse
has a minor illness

I have a seriously ill
child or spouse

5. Is your religion accepted in your home country?

Yes

I don't know

6. Is your country's health care infrastructure comparable with the U.S.

Yes

I don't know

7. Have you or a member of your family suffered any form of hardship in your country?
(this includes your mother, father and extended family)

Yes

I don't know

Your Assessment Number

What does your Assessment Number Mean?

To better understand what your Assessment Number tells you, please fill out the following form. This allows us to also better understand the needs and patterns of Foreign Physicians. Your information will not be sold, nor will you receive any unsolicited emails.

Name:
Country of Origin:
Phone:
Email address:
What year does your J-1 Status End?
How many years have you been in J-1 Status?
Comments:
Please Contact me regarding my Assessment Number:	Yes No
Your Assessment Number: