APPLICATIONS ARE NOW CLOSED FOR CPD MINI-COURSES

Due to timing, we are unable to assist with processing short-term scholar or J-1 visas to attend the program. International participants are welcome, however, you must have a current and valid visa to travel to the United States.

** All fields must be completed, or your application will not be considered.

For more information please e-mail [email protected]
or call +1 (213) 821-2078.

      
PERSONAL INFORMATION
Full legal name as it appears on your passport:
Preferred Mailing Address:
Work Address
Home Address
Street Address 1:
Street Address 2:
City:
State/Province:
Country:
Postal Code:
Work Phone (including country code):
Work Fax (including country code):
Cell Phone (including country code):
Work Email:
Alternate Email:
Sex (M/F):
EDUCATION AND EMPLOYMENT
What is the highest degree you have earned?
When was this degree awarded?
From which University?
Current Employer:
Job Title:
Duration of Current Employment:
Short Biography:
You may cut and paste from any Word document.

 

Do you have any physical difficulties that require special accommodations during the 2015 Mini-Course in Public Diplomacy? If yes, please explain:
Do you have any dietary restrictions?

 Vegetarian/Vegan
 Gluten Free
 Dairy Free

PROGRAM FEES
Please select your option:
Individual Fee (inclusive of course materials and meals) $2,250

A discount is available to organizations who send two or more participants. Please contact Stacy Ingber for more information on group discounts.

MEDIA RELEASE
I hereby grant permission to the rights of my image, likeness and sound of my voice as recorded on audio or video tape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area.
Yes
No
 I verify that I am the person identified on this form and that all of the above information about me is correct.