Host Company Portal Access Request

Host Company Portal Access Request

Complete this form to receive access to our application portal. This is a preliminary application.
Thank you for working with Cultural Vistas to host your international exchage visitor! Before submitting the form, be sure to double check that you are eligible to host!

Once you have completed the form, you will be granted access to and given instructions on completing the full application in our online system. Final evaluation of the the program will take place once both the Host Company and Participant applications have been fully submitted.

Note: All new host companies as well as companies who have not hosted in the last three years will be assessed a fee of $300 in addition to standard fees.
Company Name*
Name*

First NameLast Name
Email*
example@example.com
Title*
Referral Code
If you are working with a Cultural Vistas partner, such as a placement organization, please include the referral code so that the application is directed to the correct party.
Has your company hosted a participant with Cultural Vistas in the past 3 year?*

YesNoUnsure
How can we assist you at this time? ie are you trying to start a new application, have you lost you login information, do you have questions about other J-1 categories, etc.*

Work Site Information
Work Location Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have a valid Worker's Compensation insurance policy?*

YesNoYes, Self-Insured
Policy Carrier*
Policy Number*
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date

Participant Information

In this section, we collect information about the international visitor you will be hosting in the US.
Participant Full Name*

First NameLast Name
Participant Email*
example@example.com

How did you hear about Cultural Vistas?*

ReferralWebsite/Search Engine (Google, Bing, etc.)LinkedInOther
Referral Type*
Please provide their name and organization so that we can thank them!
If you have previously been in contact with a member of the Business Development Team, let us know who.*

Cyn RowanChristine Stephens-BezCaroline GillamI have not been in contact with a member of the Business Development Team.
Additional questions or comments.
Should be Empty:

Work Site Information