THE TIBET FUND
nd
241 East 32
, Street, New York, NY – 10016
Tibetan Scholarship Program (TSP)
Preliminary Selection Application Form
Applicant’s Full Name
1.
(As it appears in your Travel Document and Academic Credentials):
First Name: _____________________________
Last Name:_________________________________
Date of Birth: ___ ___ / ___ ___ / ___ ___ ___ ___ City and Country of Birth:
2.
____________________
RC Number
Date of Issue
Place of Issue
Valid Until
3.
_____________
_______________
______________
___________________
Green Book Number
Date of Issue
Place of Issue
Valid
4.
Until
_______________
_______________
______________
___________________
Current Address:
Permanent Address:
5.
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
E-mail address:
Phone Number:
6.
___________________________________
Have you ever applied for a U.S. visa in the past:
Yes
7.
No
8.
If yes, please fill in the details:
Date
Category
Visa Granted / Denied
Participants will be required to apply for a J-1 exchange visitor visa from the U.S. Embassy. Selection as a TSP candidate does not
guarantee approval for a visa. Applicants who have prior visa denials from the U.S. Embassy must inform the Tibet Fund and
the Tibetan Scholarship Program’s Student Selection Committee (TSP SCC) at the time of application.