UNIVERSITY OF CALIFORNIA - Berkeley Law



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: |      |

|Telephone: |      |Fax (optional): |      |

|Email: |      |

|City/State/Province/ and Country of BIRTH: |      |

|Country of CITIZENSHIP: |      |

|CURRENT POSITION: |      |

|CURRENT Home Institution or Employer: |      |

|ADDRESS of Home Institution or Employer: |      |

DEPENDENTS’ INFORMATION

|NAME |RELATION |BIRTHDATE |COUNTRY OF BIRTH |COUNTRY OF CITIZENSHIP |Enter Separately |

| | | | | |Yes 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 visa? | Yes No |

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 institution: |      |

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)

|Professor |      |, 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 |

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