22 CFR Part 62, Appendix A to Part 62 - Certification of Responsible Officers and Sponsors

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View PDF at GPO Pt. 62, App. A
Appendix A to Part 62—Certification of Responsible Officers and Sponsors
In accordance with the requirement at § 514.5(c)(6), the text of the certifications shall read as follows:
1. Responsible Officers and Alternate Responsible Officers
I hereby certify that I am the responsible officer (or alternate responsible officer, specify) for exchange visitor program number ____, and that I am a United States citizen or permanent resident. I understand that the Department of State may request supporting documentation as to my citizenship or permanent residence at any time and that I must supply such documentation when and as requested. (Name of organization) agrees that my inability to substantiate the representation of citizenship or permanent residence made in this certification will result in the immediate withdrawal of its designation and the immediate return of or accounting for all Forms IAP-66 transferred to it.
Signed in ink by
(Name)
(Title)
Witness:
This ______ day of ______, 19__. Subscribed and sworn to before me this ______ day of ______, 19__.
Notary Public
2. Sponsors.
I hereby certify that I am the chief executive officer of (Name of Organization) with the title of (specify); that I am authorized to sign this certification and bind (Name of Organization). I further certify that (Name of Organization) is a citizen of the United States as that term is defined at 22 CFR § 514.2. (Name of Organization) agrees that inability to substantiate the representation of citizenship made in this certification will result in the immediate withdrawal of its designation and the immediate return of or accounting for all Forms IAP-66 transferred to it.
Signed in ink by
(Name)
(Title)
Attestation/Witness:
This ______ day of ______, 19__. Subscribed and sworn to before me this ______ day of ______, 19__.
Notary Public

Title 22 published on 2014-04-01

no entries appear in the Federal Register after this date.