CKS Visiting Scholar Application
Basic Information
First Name
*
(as appears on passport)
Family/Last Name
*
(as appears on passport)
Email Address
*
Date of Birth
*
(format: mm/dd/yyyy)
City of Birth
*
Country of Birth
*
Country of Permanent Residence
*
Country of Citizenship
*
Gender
*
Male
Female
Home Address
*
(permanent address outside of U.S.)
Home Postal Code
*
Work Address
*
Work Postal Code
*
Phone Number
*
Married
*
Yes
No
Passport Number
*
Photocopy of Passport
*
(NOTE: you must click "Upload" after you select a file)
Expiration Date
*
(format: mm/dd/yyyy)
Research Information
Title of Research Proposal
*
Proposal
*
(1 page max.)
(NOTE: you must click "Upload" after you select a file)
Proposed Visit
Beginning Date
*
(format: mm/dd/yyyy)
(mm/01/yyyy) beginning date should be the first day of the month.
Ending Date
*
(format: mm/dd/yyyy)
ending date should be the last day of the month.
Have you previously been a UCLA Visiting Scholar?
*
Yes
No
During the last two years, have you been issued any J-1/or J-2 Status in the U.S.?
*
Yes
No
Are you currently in the U.S.?
*
Yes
No
Education Information
Highest Degree Earned
*
Bachelor of Arts
Bachelor of Science
Master of Arts
Master of Science
PhD
Professional Masters
Professional Doctorate
Date Awarded
*
(format: mm/dd/yyyy)
Curriculum Vitae/Resume
*
(NOTE: you must click "Upload" after you select a file)
Job title in Home Country
*
Employer
*
Letter of Recommendation
(for non-academics only)
(NOTE: you must click "Upload" after you select a file)
Financial Support
Funding Options
*
Personal
Employer
Funding Agency
*
Total Amount $
*
Dependents
Dependents List
+ add dependent...
Payment
A
$500
non-refundable fee is required to complete this visa application.