U.S. Department of State

U.S. Department of State TRAINING/INTERNSHIP PLACEMENT PLAN 'OMB APPROVAL NO. 14054)170 EXPIRATION DATE: 0841.2012 ESTIMATED BURDEN: 2 hours PARTICIPANT INFORMATION Trainee/Intern Name (Last, First, Ml) Email Address rainee t n one: tem tudent Intern Current Field of Study or Profession If Professional. Number of Years Experience in Field 5 years Type of Degree or Certificate BA Commerce Date Awarded (mm-&i-yyyy) or Expected Tralni Fr tes (mm-dd- To SITE OF ACTIVITY INFORMATION i i Name of Supervisor Last. First, Ml) Title Email Address Telephone Number Host Organization Name Street Address of TraininglInternship Site Suite City New York State NY ZIP Clim Website In production DUNS Number Employee Identification Number (EIN) Hours Per Week 40 Will Trainee/Intern receive a stipend? El Yes No If yes, how S per year CONTRACT AGREEMENT I understand that false certification may subject me to criminal prosecution under 18 U.S.C. 1001. which reads: "Except as otherwise provided in this section. whoever, in any matter within the jurisdiction of the executive. legislative, or judicial branch of the Government of the United States. knowingly and willfully falsifies, conceals, or covers up by any trick, scheme, or device a material fact; makes any materially false, fictitious, or fraudulent statement or representation: or makes or uses any false writing or document knowing the same to contain any materially false, fictitious, or fraudulent statement or entry: shall be fined under this Utle or imprisoned not more than 5 years, or both' NOTE- Sponsors will not enter into any contracts. issue Forms DS-2019. or allow a Trainee/Intern to begin a trainingfintemship program until all three parties have executed this Training/Internship Placement Plan and proof of the insurance required under 22 CFR 62.14 is on file with the sponsor. Trainee/Intern- I hereby acknowledge that I have reviewed, understand, and will follow this Trainingfintemship Placement Plan. Trainee/Intern Signature Date (mm-o'dyyyy) Supervisor- I certify the following: 1. I have reviewed and approved and will follow this Trainingfintemship Placement Plan; 2. I will adhere to all applicable regulatory provisions that govern this program (22 CFR Part 62); 3. I will conduct the required periodic evaluations of trainees/Interns: and 4. I will notify a designated sponsor contact (1) regarding any concerns about, changes in, or deviations from the Training/Internship Placement Plan. and (2) in the event of an emergency involving a trainee/intern. Supervisor Signature Date (mmaltyyy) Sponsor - I certify as the sponsor that the attached Training/Internship Plan is approved and that: 1. Sufficient resources, plant, equipment, and trained personnel will be available to provide the specified trainingfintemship program; 2. Continuous on-site supervision and mentoring of trainees/interns will be provided by experienced and knowledgeable staff: 3. Trainees/interns will obtain skills, knowledge, and competencies through structured and guided activities such as classroom training, seminars, rotation through several departments, on-the-job training. attendance at conferences, and similar learning experiences, as appropriate in specific circumstances: 4. Traineefintems will not displace full- or part-time or temporary or permanent American workers or serve to fill a labor need, and the positions that trainees/interns fill exist solely to assist them in achieving the objectives of their participation in training/internship programs: and 5. Training/internship programs in the field of agriculture meet all the requirements o the Falr Labor Standards Act, as amended (29 U.S.C. 201 et seq.) and the Migrant and Seasonal Agricultural Worker Protection Act, as amended (29 U.S.C. 1801 of seq.). Sponsor Signature Date (mm-dor-yyyy) Program Sponsor Name Program Number DS-7002 08-2009 Page 1 of 2 EFTA01175641 Program Sponsor Name Program Number TRAINING/INTERNSHIP PLACEMENT PLAN Each Training/Internship Placement Plan should cover a definite period of time and should consist of definite phases of training or tasks performed with a specific objective for each phase. The plan must also contain information on how the trainees/interns will accomplish those objectives (La lasses, individual instruction, shadowing, etc.). Each phase must build upon the prey ous phase to show a progression in the training/internship. A separate oopy of page 2 must be completed for each phase if applicable (La; if the traineefintem is rotating through different departments). Name of Trainee/Intem Last. First. Mi Field of Training/Internship Name of Phase Start Date for this Phase End ase Phase 4 of 5 (mm-ddlyyy) (nun-ddyy)y) Brief Description of Trainee/Intern's Role for this Program or for this Phase Developing sales strategies and learning sourcing/ pricing and mastering interior design business budgeting. Specific Tasks and Activities to be Completed for this Program or for this Phase (Interns) g Methodology of Training and Chronology/Syllabus for this Phase (Trainees) Trainee will learn to develop sales strategies and team how manage the various purchasing functions of this multi-national retail organization. Trainee will gain a detailed understanding of interior designing accessories' pricing. Additionally she will learn about the import - export process and its impact on pricing. Trainee will also gain an understanding of the variables involved from country to country. The trainee will additionally learn to develop pricing strategies with an eye towards maximizing th profits while ensuring that its clients are satisfied. Specific Goals and Objectives for this Program or for this Phase The purpose of this Phase is to gain a detailed and thorough understanding of purchasing and pricing strategies. The Trainee will also analyze and learn how pricing impacts production budgets. Knowledge, Skills, or Techniques to be Imparted During this Program or During this Phase Pricing and sourcing are the core of a successful interior design business. Current' themes and decors. The Trainee will contribute her know how about decors and the sourcing of authentic urniture, decorations, accessories, fabrics and their installation, and learn the decors utilization in the American market. Methods of Performance Evaluation and Methods or Supervision for this Program or for this Phase 30% on the job observation and 70% practical supervised work Supervisor will evaluate her weaknesses and strengths, and will explain what needs to be improved The reviews will be done on a weekly basis. PRIVACY ACT STATEMENT AUTHORITIES: The information is sought pursuant to Section 102 of the Mutual Educational and Cultural Exchange Act of 1961. as amended (the Fulbright-Hays ActX22 U.S.C. 2452) which provides for the administration of the Exchange Visitor Program (J visa). PURPOSE: The information solicited on this form is necessary to provide clarity of training and intern programs offered to foreign nationals by United States entities designated by the Department of State to conduct exchange visitor programs, for general statistical use within the Department of State, and to enable the Department of State to effectively administer the trainee and intern categories of the Exchange Visitor Program. Failure to provide the information requested on this form may result in non-participation in the Exchange Visitor Program. ROUTINE USES: The information on this form may be used in reviewing complaints, in formulating statistical data on training and internships programs conducted under the Exchange Visitor Program, and may be shared with overseas counterpart offices of the Department of State to ensure proper administration of this Program for exchange purposes. The information provided may also be released to federal, state, local, or foreign government entities for law enforcement purposes. Public reporting burden for this collection of information is estimated to average 2 hours per response, including time required for searching existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it. please send them to: A/GIS/DR, Room 2400 SA-22, U.S. Department of State, Washington. DC 20522-2202 age o DS-7002 EFTA01175642