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The Institute of Russian History Russian Academy of Sciences
(IRH RAS)

One month intensive academic programs
2003/2004 APPLICATION FORM

Please fill in this form while it is open in your browser's window.
Once you have entered all the requested information — print, sign and mail it to:
******

Please include in your package

(a) a brief curriculum vita,
(b) a check or money order for the registration and program fees.

Note: send all application materials by mail only.
Applications submitted by fax or email will NOT be accepted.

Personal information.

Last name:

First name:

Middle name: Sex:

Birthdate (MM-DD-YYYY):

Citizenship:

Position:

Department:

Institution:

Office Address:


Office Phone: ( ) Fax: ( )

Email:
Home Address:


Home Phone: ( ) Fax: ( )

Preferred address:

Program selections.
I would like to attend the IRH RAS during

.

The deadline to apply for mid-semester programs — two months
before the date of arrival.

The deadline to apply for summer programs — March 30, 2004.

I am interested in the following topic of research and specific themes:


.
Would you like to conduct at IRH the research only?

Yes No

I am interested in the following lecture courses
(please select from the list; example: A8, B3)
:


I am interested to meet with the following consultants (please select from the list):



I would like to work in following Moscow libraries:


I would like to work in following Moscow archives:


I would like to participate in Russian language practice sessions: Yes No

I will

Fee information.

The regular fee for a one month intensive academic program is $2,100.

The special May 24 -- August 30, 2004 fee for a one month intensive program is

$1,550 for individuals and
$1,450 for each member of a group of 5 or more.

The registration fee is

$40 for Summer programs and
$25 for Mid-semester programs.

The registration fee will not be refunded under any circumstances. The program fee will be refunded if requested at least two weeks prior to the starting date of the program.

The payment must be in the form of a check or money order in U.S. currency drawn upon a U.S. bank, made payable to Interuniversity Centre Canada


I am attaching my check / money order for $_______ which includes my registration fee and the academic program fee.

Signature :___________________________ Date:______________________

 

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This page was last updated March 8, 2003
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Janice Vincent