Application Form

The start your VIS/UM application process, please submit the Application Form below.

In addition, please fill out the following Liability Waiver Form and attach it on your application below.

NOTE: The application fee for the VIS program & the UM program are implemented to cover the cost of services and secure participants’ position.

Personal information
Name * Required
First (Given) Name Last (Sur) Name
Date of Birth * Required
MM
DD
YYYY
Citizenship * Required
Phone
Email * Required
Enter Email Confirm Email
Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Institutional information
Home institution name * Required
Your position * Required
Department * Required
Institution phone * Required
Institution website - enter a valid website URL for example https://www.google.com/ * Required
Institution address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Visit information
Purpose of visit * Required
- Research
- Teaching
- Internship
- Other
Expected Arrival Date - must be mm/dd/yyyy format * Required
Date Format: MM slash DD slash YYYY
Expected Departure Date - must be mm/dd/yyyy format * Required
Date Format: MM slash DD slash YYYY
Topic/field of research proposed * Required
Potential academic host/supervisor at Brock * Required
Name Department
Do you have a previous working relationship with the proposed host/supervisor? * Required
- Yes
- No
Funding information
Source of funding * Required
- Personal
- Scholarship
- Other
Please provide detail * Required
Attachments
Institutional letter of support * Required
Accepted file types: pdf.
Proof of funding
Accepted file types: pdf.
Please note that we require proof of funding prior to your arrival Brock University. If you're unable to upload proof now, please send it via email to globalscholars@brocku.ca prior to your arrival.
Academic CV * Required
Accepted file types: pdf.
Specific goals and objectives * Required
Accepted file types: pdf.
Liability Waiver Form (see top of page) * Required
Accepted file types: pdf.
Brock University protects your privacy and your information. The personal information requested here is collected under the authority of The Brock University Act, 1964, and in accordance with the Freedom of Information and Protection of Privacy Act (FIPPA). The information provided will be used by the University to continue the conversation with you about being a Brock Global Scholar.
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Application Form

The start your VIS/UM application process, please submit the Application Form below.

Personal information

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Visit information

Funding information

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Application Form

The start your VIS/UM application process, please submit the Application Form below.

Personal information

Institutional information

Visit information

Funding information

Attachments

More Information

Events calendar

Connect with us