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: Mr Ms SENIOR VISITING SCHOLAR VISITING RESEARCHER FAMILY/LAST NAME, FIRST, MIDDLE ANTICIPATED DATE OF VISIT: Mailing Address: From: Fax (optional): City/State/Province/ BIRTH: and Country of CITIZENSHIP: CURRENT POSITION: Country of CURRENT Home Institution or Employer: ADDRESS Employer: Telephone: Email: To: of Home Institution or 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: TOEFL Score (if taken before): Yes No Computer-based Written Have you previously applied to any of UC Berkeley’s Visiting Scholars Programs? If yes what year? Purpose of your visit: Decision? Yes No Department ? Yes YOU MUST ATTACH A ONE-PAGE SUMMARY OF YOUR PROPOSED RESEARCH Name of Funding Agency: Type of Funds (Check one): Amount of Funding : Government U.S $ University Per month OR $ (Amount in U.S Dollars) Personal Business For the entire visit (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 No (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: FACULTY SPONSORSHIP (All Visiting Researchers and Visiting Scholars are required to have a faculty sponsor) Professo , of the University of California, Berkeley School of Law has r agreed to act as my sponsor during my visit If possible, I would like to meet with Professors in the following areas of expertise: 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