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If you prefer, you may print this form out and fax it to us at (302) 831-3348.
What is your passport number?
By what country is your passport issued?
What is your passport expiration date?
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Have you ever been issued a Social Security Number or a Tax Payer Identification number by the U. S. Government? These numbers are in the format 123-45-6789.
If you answered Yes, what is your Social Security or Tax Payer Identification number?
When your name is written, do(es) your given name(s) or your family name(s) appear first?
Many people do not use their full name in daily conversation and general correspondence. Please help us to understand how you should be addressed:
In general correspondence of a business or academic nature how should you be addressed (if in such communications you use a different title than the one indicated above, please include it as well)?
In the United States, colleagues often use one another's given name - or a nick name - when speaking informally with one another. In informal conversation, by what name would you like to be called? (If you prefer to be addressed only formally, please write "use formal name.")
In the United States, when one is verbally introduced to a stranger, one is often introduced by one's given name and one family name; sometimes a title or rank (such as Professor, Dr., or Captain) is included in such cases. When being verbally introduced to another person, what names should be used? Include any title which ought to be included with you name in such a circumstance:
In the United States, it is customary to wear a name tag in certain circumstances. If you were at an academic or business conference lasting just a day or two, what name(s) would you expect to have on your name tag?
What is your complete office mailing address?
What is your email address?
What is your office telephone number?
What is your complete home mailing address?
What is your home telephone number?
What is your mobile telephone number?
What is your office fax number?
Which address should the Institute use for general correspondence?
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Which address should your colleagues use for general correspondence?
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Where would it be best to receive packages from the Institute once you have returned from the United States?
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Would you like a smoking or non-smoking hotel room?
We will be flying US Airways to Boston; you may earn frequent flier miles for this trip. Which of the following (if any) airlines would you like to receive miles on?
Do you have any medical conditions which limit your ability to walk?
Do you have any other medical conditions which we should know about or are you on any prescription medications?
Do you eat beef?
Do you eat pork?
Do you require that meat you eat be butchered in a religious/ritualistic manner?
Do you eat fish?
Do you eat shell-fish?
Do you eat only vegetarian?
If you eat only vegetarian, do you eat eggs?
If you eat only vegetarian, do you eat/drink dairy products?
Do you drink alcohol?
Do you have any other dietary restrictions? If so, please describe?
Please list any places where you have lived or traveled outside your country:
What are your current intellectual and research interests?
What would you most like to accomplish during this program? For example: Expand intellectual horizons, foster inter-institutional dialogs, foster dialogs with other scholars, or participate in cultural activities.
In addition to activities organized by the Institute, what are you most interested in seeing/doing during your visits to Washington, New York, and Boston?
Although the Institute's schedule is quite busy, do you need time to meet with anyone while you are in the United States? If so, in what city would you meet?
What are your hobbies and interests?
What is your favorite movie about American politics or the United States on the international stage?
Name the one book, either non-fiction or fiction, which you believe would be the most useful for a person from your country wanting to learn about the United States (but who has never read anything about the United States) to read.
What would you most like to learn about the United States and its people?
During your stay the Political Science Department is offering a class called "Problems in American Foreign Policy". Would you be interested at some point in talking to students in this class?
What is/are your greatest reservation(s) about the Institute or visiting the United States?
The Institute has a full calendar of activities. Are there any personal or religious issues which might impact your participation?
List any post secondary degrees obtained and the fields of study:
Describe any courses or other forms of continuing education you are presently involved in as a student:
List any courses that you regularly teach, are teaching now, or plan to teach in the near future:
Does your institute regularly send faculty members to other countries as part of faculty exchange programs with other universities?
Does your institute regularly send students to other countries as part of student exchange programs with other universities?
Does your institute regularly receive faculty members from other countries as part of student exchange programs with other universities?
Does your institute regularly receive students from other countries as part of student exchange programs with other universities?
Does your institute have videoconferencing facilities?
Are there any special ways in which we can help make you feel more comfortable during your stay?
Is there anything else we need to know?
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