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*
Home Address *
(permanent address outside of U.S.)
Home Postal Code *
Work Address *
Work Postal Code *
Phone Number *
Married*
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?*
During the last two years, have you been issued any J-1/or J-2 Status in the U.S.?*
Are you currently in the U.S.?*
 
Education Information 
Highest Degree Earned *
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 *
 
Funding Agency *
Total Amount $ *
 
Dependents
Dependents List + add dependent...
 
Payment
A $500 non-refundable fee is required to complete this visa application.