PERSONAL INFORMATION
Full legal name as it appears on your passport:
Current Mailing Address:
City, country of residence:
ZIP or postal code:
Home phone (including country code):
Home fax:
E-mail address:
Sex: M or F:
Date of Birth (mm/dd/yy):
Birthplace (City, Country):
Citizenship:
EDUCATION AND EMPLOYMENT
What is the highest degree you have earned?
Date awarded:
From what University?
What is your current place of employment?
Duration of current employment:
Job Title:
List any other relevant experience in the space below:
VISA INFORMATION
If you are not a U.S. citizen, permanent resident, or have not been granted political asylum, you will need a DS-2019 Form from USC to apply for your J-1 exchange visitor visa.
HOUSING REQUEST
Do you want to stay in University housing?
Housing fees are listed per person and the cost is for the 12 nights of the Summer Institute. Please check only ONE option:
FOOD Do you want to pay for all your meals in advance?
Do you have any physical difficulties that require special accomodations? If so, please explain what special accomodations you will need in the space below:
If housing is full, we will notify you and ask if you wish to be placed on a waiting list or if you would like to cancel your reservation. All USC apartments are non-smoking facilities.
PROGRAM FEES
Please check one box:
How did you hear about the Public Diplomacy Summer Institute?
Please send payment in the form of a check to:
Summer Institute 2008, c/o Lisa Larsen
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