The American University in Cairo
Visiting Scholars Application Form

 
  The information on this form is used for a variety of key University processes and it becomes a part of your permanent record. It is important that this information be complete and accurate.
 
1.
Name (as in passport or National ID):
 
First
Middle
Last
 
  Department    
     

2. Address:
  (a) Current Address
 
 
Email
Telephone (Home)
Telephone (Office/Other)
Cell Phone
 
  (b) Permanent Address  
 
  Telephone      
       
         
  Contact in case of any emergency while resident in Cairo:
  Name Phone Email  
   
         

3. Date and Place of Birth:
  Date Place (City/State or Province/Country)
 

4. Sex:
  Female Male

5. Marital Status :
  Single Married

6.
Dependents:
  Spouse:
 
Name
Date of Birth
Citizenship
Will reside with
you in Egypt?
 
Yes No
  Children:
 
Name
Date of Birth
Citizenship
Will reside with
you in Egypt?
 
Yes No
 
Yes No
 
Yes No
 
Yes No
  Yes No
 
Other:
 
Name
Relationship
Citizenship
Will reside with
you in Egypt?
  Yes No

7.
Citizenship:
 

A.
List ALL countries of which you are a citizen:
 
B. Please answer ALL that apply to you:
a. US Citizen:
  Passport no. Date of Issue
 
  Place of Issue Social Security no.
 
b. Egyptian Citizen:
  Passport no. Date of Issue
 
  Place of Issue Identity Card no.
 
c. Citizen other than a & b:
  Passport no. Date of Issue
 
  Place of Issue Country
 

C. If you are a US Resident Alien ("Green Card" holder), please complete the following:
  US Alien no. Social Security no. Date of Issue
 


Date Submitted: