2 wilich will FORINTERNATIONALDEVELOPMENT U s INTERNATIONAL DEVELOPMENT COOFERATION AGENCY ro participate in me EXCHANGE PROGRAM NO 0-2-0255 which is still valid and is criso'auy described as renews JUL-uu-uu lur w-w nu F019 UNIT FAX N0 819 557 5314 P 02 VT 1 - 0MB mum-129 I 555590 -07 STAN-IE FORM I i Z'xpirauon Dal i2-31-8'i 1 AGENCY ran sureanmoum navaomam- unrr'en' art-res m' inhuman AGENCY - WW5 5 me ASSOCIATE nungcronxra FOR soucmonm AND CULTURAL AFFAIRS Control No 1 6 5 2 or r-on excumaa PART 1 IT IS HEREBY CERTIFIED THAT xi Mm THE PURPOSE or mus FORM 3 TO UXQI Wt Male 1 x Begin a new proamm' MMILY NAME OF EXCHANGE VISITOR MIDDLE NJMEJ born 4 7 a Sana a - Re ublic Of Yemen 3 i intend an on 90 Druram Day in rain 3 Transfer to a differunr program 1 a legal permanent resident of mm g 3813 1 whose posllhan In - Cerium 0er 4 Replace a lost form thai country Student gar-mil visitor s immedlam iamny - truer US warmly- 1 U-S addressc lo AnnVOyer 0311 Fort 10111115 CO 80523 A program b the Agmcy for Immune Dwelopme ni 0 3 Inwmarianai Cooperation Agency to bringparlicipanr to I11 United States f6 mining academic study obsemau'm-r ar consultation in keeping with the objective of human resource dwriopmenr a nonrained in the Foreign Assistance Act of 1961 as amended Consortium for Internationa PM No 279-051-1-901b6' 0 3 NO Development Contractor Devi Ya 1M9 Day Hr 1 this form is for family travel 0r replaces a lqat farm the sxpiralion date on the exchange visitor's 1-94 is 4 The category of this visitor is 1 Sargent 2 ifralnee 3 l eacner 4 i Profs-ear Resomgh scholar r Spoqinlist 6 i 1 International Visitor 7 Prolessional Trainee and the speci c e ucatlonai held or don-fludv activity to be Ingaued'in is Code No LEA vorbauy described as follows Subifh'ald cm 3 This form carer in period from u __301 3 1a lone veer maximum Passport No 51226365 Clint Engineering 5 During the prirlod covered by this harm it is estimates that the foliowing financial support in U55 will be provided to Ihls exchange visitor by I a X TheIProaram Sponsor in item 2 abm 3 Am rOVides in-11 funding Financial suppon from granulation nthar than the sponsor will he provided by one or more oi the bllowing b1 1 US Codai 2 Agency Gods c1 international Organlzatlonis Ina Org Code 5 Int Org a The Exchange Visitor s Government it necessary usc above snaccs - - lor by multiple US a The bunational oi the vmtlor s Counlry 3 Agencies or lnli Organizations I i All other Olganlzatlons prcviding support 5 9- 6 ms use m mmr Marv-uh- 7 Robert Schmading EHRD Officer wig Name of Official Prapan'ng Form - Tim iUikmn 7 t 333% a 0 77 a Responsible Of cer or Aim-rm - il -ENDORSEMENT OF CONSULAR OR IMMIIRATION ill OF RESPONSIBLE OFFICER 70R RELEASING OFFICER REGARDING SECTION 212 e OF THE I M A SPONSOR FOR TRANSFER OF No endorsement o Consular br Immigration Gilles regarding Sea 212G Dine Wham oi this exchange visitor from of the and Naiuralizailon Mr is necessary becauss nwgram No sponsored by ALL AID ARE SUBJECT TO THE TWO YEAR ngsmeuca agoumgm EMT to the program spe clfiad In item 2 la nauasary or highly desirable and is in coulormily with the obiectives or the Mutual Educational and Cultural Act or 1961 Keypunch Inlcirmatlon Cal 133 Col 139 1 C01 140 i Si nature of Offircr Dru-l IAP 66A 2 33 - page1 iwlaki-MZ