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Application Form


Please indicate for which program you are applying(*)
Please select an option

Title(*)
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First Name(*)
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Last Name(*)
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Position/Title(*)
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Work Address(*)
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Work City(*)
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Work State
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If applicable, select the state in which you work.

Work Zip Code
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Work Country(*)
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Phone Number(*)
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Please enter your complete phone number including country code if outside of the USA.

E-mail(*)
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Supervisor or Advisor or Dean(*)
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Additional Information

Is there funding for your visit available from your home institution?

Funding(*)
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Explain
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How will you cover travel and living cost during your visit?

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Visiting scholars are required to have a faculty mentor. If you had previous contact with a UAB-SON faculty member, please provide the faculty member’s name and nature of your communication below.

If you did not have previous communications with a UAB-SON faculty member, please identify at least one suitable faculty mentor at UAB-SON. Our list of potential faculty mentors can be accessed online by clicking here.

Have you had previous contact with a UAB-SON faculty member?

Faculty Mentor(*)
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Faculty Mentor Name(*)
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Communication
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Possible Faculty Mentor(s)
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Area of Interest
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Goals
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Dates and Duration
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Upload Documents

Please use the section below to upload digital copies of the following documents:
REQUIRED:

  1. Curriculum Vitae (CV)
  2. Statement of purpose, goals and expected deliverables for the visit - fill out this form.
  3. Proof of English language proficiency (TOEFL or IELTS scores, or UAB EPT score).
  4. Funding proof
Document 1
The maximum file limit size is 5MB. The acceptable file types are pdf, doc, docx. ppt or pptx.

Maximum File Size: 5MB
Allowable File Types: doc, docx. pdf, ppt or pptx

Document 2
The maximum file limit size is 5MB. The acceptable file types are pdf, doc, docx. ppt or pptx.

Maximum File Size: 5MB
Allowable File Types: doc, docx, pdf, ppt or pptx

Document 3
The maximum file limit size is 5MB. The acceptable file types are pdf, doc, docx. ppt or pptx.

Maximum File Size: 5MB
Allowable File Types: doc, docx, pdf, ppt or pptx

Document 4
The maximum file limit size is 5MB. The acceptable file types are pdf, doc, docx. ppt or pptx.

Maximum File Size: 5MB
Allowable File Types: doc, docx, pdf, ppt or pptx

Application Fee

After clicking "Submit", you will be redirected to a site where you may pay the $100.00 application fee (non-refundable) via credit card. All payments are to be made in US dollars.
Please click the box
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