Visiting Scholar, Visiting Student Inquiry Form Visiting Scholar / Visiting Student Inquiry Form Heading link Copy link Full Name * Required Given/First Name Middle Surname/Last Name (as it appears in your passport)Email Address * Required Current Title Current Institution Country of Institution Are you currently or have you ever been licensed/certified as a nurse in any jurisdiction? Yes No What is the name of jurisdiction? Are you currently a student? Yes No Would this program be related to your current degree program at your home institution? Yes No Your MAIN goal for a visiting scholar program is: To improve your research skills and/or to work on your existing research To observe in a clinical setting To learn about current nursing education methods To learn about current clinical nursing management practices Timing of proposed visiting programIf you are interested in collaborating with a specific UIC Nursing faculty member, please list their name. You would like to start your program in:Fall Semester [August-December] – submit inquiry form by May 31Spring Semester [January-May] – submit inquiry form by Sept. 1Note: UIC Nursing is unable to accommodate individual visiting scholars during the summer (mid-May – mid-August)Your proposed program would last: Days Week(s) Month(s) Semester(s) Year(s) Number of units above Do you have a deadline for acceptance into a Visiting Scholar program? Yes No Deadline Date MM slash DD slash YYYY Please provide details regarding your deadline.English language skillsPlease complete the sentences below.I believe my English written skills are...BasicIntermediateAdvancedI believe my English verbal skills are...BasicIntermediateAdvancedI believe my English listening skills are...BasicIntermediateAdvancedWill you be accompanied by any dependents? Yes No Please list the number of dependents who will accompany you. Other relevant informationWhat else should we know about your proposed program?Attach Current CV or Resume * RequiredAccepted file types: pdf, doc, docx, Max. file size: 5 MB.Maximum file size - 5 mega bytes. Attach Proposal for Program Plan * RequiredAccepted file types: pdf, doc, docx, Max. file size: 5 MB.Maximum file size - 5 mega bytes. *Click to see an example Program Plan