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DS2019 SCHOLAR REQUEST FORM

This form is to be used by SIUE Faculty to request DS2019 for a Scholar.


Type  


PERSONAL INFORMATION

Visitor's Last(Family) Name Middle Name First Name
Gender Birthday (MM-DD-YYYY) City of Birth
Country of Birth Country of Citizenship Country of Permanent Residence
Position in Home Country Permanent Mailing Address Email Address

FINANCIAL SUPPORT

(Funds verifying the availability of at least $1,800 per month or $7,500 per semester are required)

A letter on SIUE letterhead must be provided indicating the amount of the award, signed by Chair/Hiring Authority.A letter on Home Institution letterhead must be attached indicating the amount of the award or Financial documentation must be attached in the form of a bank statement/letter on bank letterhead, not older than 90 days, signed and dated by the bank manager. Email documents to satamar@siue.edu
SIUE ($) Non-SIUE ($)

ENGLISH ABILITY

TOEFL requirement - 79 or higher on the iBT; 213 or higher on the CBT; 550 or higher on PBT or Institutional TOEFL
IELTS requirement - overall band score of 6.5*Research Scholars who are not teaching or attending classes may submit a letter from appropriate University faculty at your present institution attesting to English ability.A letter on Home Institution letterhead must be attached indicating the amount of the award or Financial documentation must be attached in the form of a bank statement/letter on bank letterhead, not older than 90 days, signed and dated by the bank manager.
TOEFL or IELTS score - (no older than 2 years-must be emailed to satamar@siue.edu)

PROGRAM INFORMATION

The category of this visitor is: (Please click below) Maximum Time limit:
Professor

5 Years

Research Scholar

5 Years

Short Term Scholar

6 months


PROGRAM OBJECTIVE

Applicant must provide a specific description of their objective: (Example: To participate in research on the policies, management and practices of wastewater biosolids disposal.)

I AM REQUESTING TO:
(Please select appropriate option below)

Begin New Program in U.S.
Transfer from another U.S. school
*Attach copy of current DS2019

Date to begin at SIUE (MM-DD-YYYY):       Date to end (MM-DD-YYYY):   

FAMILY MEMBERS

If family is accompanying exchange visitor, please complete this section:

Name Relationship Birth  Birthplace City Country of Citizenship Country of Residence

Faculty Information:

Name of Faculty Contact Phone

Hiring Authority Information:

Chair/Hiring Authority Name Title Department
Phone E-mail Fax number
Date


SIUE International Student Services, Box 1616, Edwardsville, IL, 62026-1616
Phone: 618-650-3785     Fax: 618-650-5099


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