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Conrad 30 J-1 Visa Waiver Information, Instructions & Forms


Please contact us at nvpco@health.nv.gov if you have any questions, trouble accessing any of the forms/instructions, issues with any of the formatting, notice any errors, or have suggestions for improvement.

    PCO staff are telecommuting to help limit the spread of COVID-19. We will do our best to conduct business as usual and ask that you inform us if you plan to send something to our office (e.g. via FedEx, mail, etc.) so that we can take appropriate action.

      Information, Instructions & Forms

      Conrad 30 J-1 Visa Waiver Application Instructions FFY2021

      Instructions for submitting an application

        Application Attestation Form

        Employer and Physician to submit Application Attestation form at time of application.


          PHYSICIAN Affidavit and Agreement Sponsorship and Eligibility Requirements

          Physician to submit at time of application an Affidavit and Agreement Sponsorship and Eligibility Requirements agreement.


            EMPLOYER Affidavit and Agreement Sponsorship and Eligibility Requirements

            Employer/Sponsor to submit at time of application an Affidavit and Agreement Sponsorship and Eligibility Requirements agreement.


              Verification of Status

              Complete a Verification of Status form upon start date.


                Physician & Employer/Sponsor Rights and Responsibilities Presentation

                Upon starting, both the Sponsors/Employers & Physicians participating in the Nevada Conrad 30 J-1 Visa Waiver Program are to read through the Rights and Responsibilities presentation, understand and acknowledge their Rights and Responsibilities.


                  Physician & Employer Compliance Confirmation Verification

                  Complete Physician and Employer Compliance Confirmation Verification form semi-annually. Each April and October for the prior six-month period all employers of physicians practicing medicine in the State of Nevada under a J-1 Visa Waiver supported by the Nevada Division of Public and Behavioral Health (DPBH) are required to confirm that the physician is providing a minimum of 40 hours a week of primary care in a practice site(s) located in an underserved area.


                    Change of Status

                    A change of status form to be completed and approved by DPBH when there would be a change in practice location, provider discipline or employer.


                      Board of Health Variance Application

                      Application to request a variance with the Nevada State Board of Health for any person who, because of unique circumstances, is unduly burdened by a regulation of the State Board of Health and thereby suffers a hardship and the abridgement of a substantial property right may apply for a variance from a regulation. NAC 439.200(1).