Visiting-Scholar-Online-Application_20151203121018_934099

BOALT HALL – SCHOOL OF LAWAPPLICATION FOR VISITING SCHOLAR STATUS INSTRUCTIONS: PLEASE COMPLETE ALL ITEMS, UNLESS OTHERWISE NOTED.. APPLYING AS: SENIOR VISITING SCHOLAR VISITING RESEARC

BOALT HALL – SCHOOL OF LAW

APPLICATION FOR VISITING SCHOLAR STATUS

INSTRUCTIONS: PLEASE COMPLETE ALL ITEMS, UNLESS OTHERWISE NOTED.

DO NOT USE ABBREVIATIONS, FOR INSTITUTIONS LISTED.

ALL DATES MUST FOLLOW THIS FORMAT: MONTH/DAY/YEAR.

APPLYING AS: SENIOR VISITING SCHOLAR

VISITING RESEARCHER

Mr

Ms      

FAMILY/LAST NAME, FIRST, MIDDLE

ANTICIPATED DATE OF VISIT: From:       To:      

Mailing Address:      

City/State/Province/ and Country of

Country of CITIZENSHIP:      

CURRENT POSITION:      

CURRENT Home Institution or Employer:      

ADDRESS of Home Institution or

DEPENDENTS’ INFORMATION

NAME RELATION BIRTHDATE COUNTRY OF

BIRTH COUNTRY OFCITIZENSHIP Enter SeparatelyYes or No?

Name of person to be notified in case of an emergency:      

Permanent Address:      

Telephone:      

Do you speak conversational English: Yes No

TOEFL Score (if taken before):       Computer-based Written

Have you previously applied to any of UC Berkeley’s Visiting Scholars Programs? Yes No

If yes what year?       Decision? Yes No Department

Purpose of your visit:      

YOU MUST ATTACH A ONE-PAGE SUMMARY OF YOUR PROPOSED RESEARCH Name of Funding Agency:      

Type of Funds (Check one): Government University Personal Business Amount of Funding : U.S $       Per month OR $       For the entire visit

(Amount in U.S Dollars) (Amount in U.S Dollars)

If invited to come as a Visiting Scholar, will you need a

EDUCATION

Dates of Attendance Name of School Location Subject Major Degree

PREVIOUS EMPLOYMENT OR AFFILIATIONS

DATES INSTITUTION/ FIRM/ ORGANIZATION AND LOCATION RANK/TITLE/

POSITION

Specific subjects taught/researched at home

MEMBERSHIPS

(Scholarly Societies, Accreditation Boards, Civic Organizations, etc)      

HONORS, AWARDS      

BIOGRAPHICAL DATA Use the following space for biographical data that you desire to have become a part of your record

at Boalt Hall School of Law If more room is required, please attach an additional shee.

FACULTY CONTACTS AT BOALT HALL

I,       , am personally acquainted with or have corresponded with The following member(s) of the faculty at the University of California, Berkeley, School of Law:

1      

2      

3      

FACULTY SPONSORSHIP

(All Visiting Researchers and Visiting Scholars are required to have a faculty sponsor)

Professo

r       , of the University of California, Berkeley School of Law has agreed to act as my sponsor during my visit

If possible, I would like to meet with Professors in the following areas of expertise:

1      

2      

I understand that the University of California, Berkeley, School of Law (Boalt Hall) cannot provide office space, office equipment, storage space, computer equipment or support of any kind, or secretarial/clerical services for Visiting Scholars, and that email access is not provided through the School of Law and is available only through the Central Campus at locations outside Boalt Hall By

typing my name below, I agree that this is valid as my signature.

Signature Date of Application

Due to the large number of requests and severe space restrictions, we must limit the number of scholars visiting at any one time You may expect to receive a response within 30 days after

receipt of your application

Please return completed application to: visitingscholars@law.berkeley.edu

OR

VISITING SCHOLARS PROGRAM

University of California, Berkeley

School of Law

353A Boalt Hall

Berkeley, CA 94720 USA