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CKS Visiting Scholar Application 2022
Basic Information
First Name
*
Last Name
*
Email Address
*
Confirm Email Address.
Date of Birth (mm/dd/yyyy)
*
City of Birth
*
Gender
*
Male
Female
Home Address
*
Work Address
*
Phone Number
*
Married
*
Yes
No
Passport Number
*
Photocopy of Passport
*
(NOTE: you must click "Upload" after you select a file)
Expiration Date (mm/dd/yyyy)
*
Country of Citizenship
*
Research Information
Title of Research Proposal
*
Proposal
*
(NOTE: you must click "Upload" after you select a file)
Proposed Visit
Beginning Date, starting at the beginning of the month (mm/dd/yyyy)
*
Ending Date (mm/dd/yyyy)
*
Have you previously been a UCLA Visiting Scholar?
*
Yes
No
Education Information
Highest Degree Earned
*
-- Select One --
Bachelor of Arts
Bachelor of Science
Master of Arts
Master of Science
PhD
Professional Masters
Professional Doctorate
Date Awarded (mm/dd/yyyy)
*
Curriculum Vitae/Resume
*
(NOTE: you must click "Upload" after you select a file)
Occupation in Home Country
*
Employer
*
Letter of Recommendation (non-academics only)
(NOTE: you must click "Upload" after you select a file)
Letter of English Language Proficiency
*
(NOTE: you must click "Upload" after you select a file)
Financial Support
Funding Options
*
Personal
Employer
Funding Agency
*
Funding Amount (USD $)
*
Financial Support Letter
*
(NOTE: you must click "Upload" after you select a file)
Dependents
Number of Dependents
*
-- Select One --
0
1
2
3
4