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King Abdullah University for Science & Technology Office of
Student Recruitment Initiatives
Last Updated 08-Jan-13
Visiting Student Research Program (VSRP) Application
Student Information
Name Date of Birth
Email Skype Name (if any)
Gender Residing in (Country)
Nationality Passport/Saudi ID/Iqama No.
Mobile Number Home Number
Research Program Applying For
Research Title
Research Code
Current/Previous Institution(s) & Degree(s)
University 1 Name Degree
Country Major
Dates Attended From: To: cGPA Out of
Actual/Expected Graduation Date: cGPA 4.0 Scale
Is English the language of instruction Yes No
1
University 2 Name (if any)
Degree
Country Major
Dates Attended From: To: cGPA Out of
Actual/Expected Graduation Date: cGPA 4.0 Scale
Is English the language of instruction Yes No
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King Abdullah University for Science & Technology Office of
Student Recruitment Initiatives
Last Updated 08-Jan-13
Research, Posters & Publications (if any)
Document Type Date Status
Collection Name of Document
Document Type Date Status
Collection Name of Document
Recommendation Provider Details
Name Email
Mobile Phone Office Phone
Employer Country
Title Relationship to Applicant
Required Documents
Academic Transcript(s) Statement of Purpose SOP Resume/CV
Recommendation Letter Image of Passport/Saudi ID/Iqama No. Copy of
International Health Care Coverage (if applicable)
Emergency Details (two contacts)
Contact 1 Name: (first, middle, last) Relationship to
Student:
Email:
Mobile Number (country code + area code + number) Other Number
(country code + area code + number)
Contact 2 Name: (first, middle, last) Relationship to Student:
Email:
Mobile Number (country code + area code + number) Other Number
(country code + area code + number)
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King Abdullah University for Science & Technology Office of
Student Recruitment Initiatives
Last Updated 08-Jan-13
Student Home Address
Address Line 1 City/Town
Address Line 2 Zip (postal) Code
Address Line 3 Country
Digital Signature
I certify that the information supplied by me on this form is
true and correct to the best of my knowledge.
Digital Signature/Full Name:
Date:
Please email completed Application to [email protected]
Name: Date of Birth: Email: Skype Name if any: Residing in
Country: Nationality: PassportSaudi IDIqama No: Mobile Number: Home
Number: Research Title: Research Code: University 1 Name: Degree:
Country: Major: From: To: cGPA: Out of: ActualExpected Graduation
Date: cGPA 40 Scale: University 2 Name if any: Degree_2: Country_2:
Major_2: From_2: To_2: cGPA_2: Out of_2: ActualExpected Graduation
Date_2: cGPA 40 Scale_2: Document Type: Date: Status: Collection:
Name of Document: Document Type_2: Date_2: Status_2: Collection_2:
Name of Document_2: Name_2: Email_2: Mobile Phone: Office Phone:
Employer: Country_3: Title: Relationship to Applicant: Contact 1
Name first middle last: Relationship to Student: Email_3: Mobile
Number country code area code number: Other Number country code
area code number: Contact 2 Name first middle last: Relationship to
Student_2: Email_4: Mobile Number country code area code number_2:
Other Number country code area code number_2: Address Line 1:
CityTown: SigDate: Gender: Full Name: AddressRow2: AddressRow3:
zip: Home_Country: Check Box1:
Check Box2:
