KITP - Affiliate Form

KITP PROGRAM AFFILIATE NOMINATION FORM

NOTE: This form is not to be completed until after you have received and accepted an official invitation to participate in one of our programs.

Nominator Information:

First Name:

Last Name:

Email Address:

Activity I am participating in:

I have been officially invited for the following dates:

(Please select both your start and end dates in the datepicker
or format your entry to match mm/dd/yyyy - mm/dd/yyyy.)

Nominee Information:

First Name:

Last Name:

E-Mail:

I would like my Affiliate's visit dates to be:

(Please select both your Nominee's start and end dates in the datepicker
or format your entry to match mm/dd/yyyy - mm/dd/yyyy.)
(Also ensure your Nominee's visit dates are subset of your own,
unless other arrangements have been made with the organizers.)

To complete this application, please describe the affiliate,
and explain why she/he is suitable for such a program.

If you have any questions, contact Deborah Storm
Last modified: 5/07/08.