Resident WSD-Handa Fellowship Application

Resident WSD-Handa Fellowship Application

Applications close on November 7.
Please select your desired six month resident fellowship period:

January 1-June 30, 2023
Personal Data
Name*

Surname (Last) NameGiven (First) Name
Permanent Address*

Street Address

Street Address Line 2

CityState / Province / Country

Postal / Zip Code
Date of Birth*

MonthDayYear
Gender*

FemaleMale
Country of Citizenship*
Phone Number

Country/Area CodePhone Number
Primary Email*
Secondary Email

Education*

	Degrees Obtained or In Progress	Major	Name of School	Month/Year Degree Received or Expected
1
2
3
4

Proposed Dates of Fellowship (Start)*

MonthDayYear
Proposed Dates of Fellowship (End)*

MonthDayYear

Provide two references we can contact. *

	Name	Title	Affiliation	Phone Number	Email
1
2

Immigration
If not U.S. citizen, but currently in U.S., what is your visa status?
I-94 Number
Immigration Start Date

MonthDayYear
Expiration Date

MonthDayYear
If currently in J status, do you have medical coverage of at least: $100,000 per accident/illness, $25,000 for repatriation, $50,000 for medical evacuation, and $500 deductible for yourself and your dependent(s)?

YesNo
Have you been in the U.S. on J-1 or J-2 status within the past 24 months?

YesNo
If yes, please attach copies of all previous DS-2019s.

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Upload Materials

Please upload your cover letter, resume, description of research project, a letter of recommendation and any other supplemental documents below, or send materials in one email to programs@pacforum.org. Recommendation letter may be submitted separately by the letter writer to programs@pacforum.org or along with the required materials listed above.
1. Cover letter *

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2. CV/Resume*

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3. Description of research project*

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4. Letter of recommendation*

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5. Brief Biography*

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Applicant's Certification
I, the undersigned, hereby certify that the information I have given on this application is complete and correct to the best of my knowledge and that I have attended no institution other than those listed on this application. I understand that the concealment of such information may result in the rejection of my application or disciplinary action if discovered after acceptance.
Signature*

Clear
Date*

MonthDayYear
Should be Empty:

Resident WSD-Handa Fellowship Application

Personal Data

Immigration

Upload Materials

Applicant's Certification