University Programs Information Form - BIOS

Reason for visiting BIOS

Internship*

Internship mentor*

Internship project title*

Course participant*

If 'other' please specify here

Instructor / TA*

If 'other' please specify here

Workshop participant*

Yes
No

Workshop name

If you are a workshop participant please specify the workshop name here

Your Details

Name*

As it appears on your passport

Prefix First Middle Last

Preferred name

If different from passport

Gender*

As it appears on your passport

Female
Male

Date of birth*

Passport issuing country*

Country

Citizenship

If different to passport

Current address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mobile phone number*

Home phone number*

Primary email address*

Alternate email address*

Current university / college / employer name*

Current university / college / employer address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Current university / college website*

University / college ID number

Academic accommodations*

Roommate request

If applicable

Vegetarian*

Yes
No

Medical / health issues or accessibility needs that BIOS should be aware of*

Emergency Contact Information

Name*

First Last

Relationship to applicant*

Do the applicant and emergency contact have the same address?*

Yes
No

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Flight Information

Arrival date

Arrival flight airline

Arrival flight number

Arrival flight time

Departure date

Departure flight airline

Departure flight number

Departure flight time

Passport number*

Passport expiry date*

Is BIOS University Programs booking your flights?*

Yes
No

Preferred departure airport*

Include name, state, country, airport code

Preferred return airport if different from above

Include name, state, country, airport code

Please advise any time constraints*

Documents Checklist

Please indicate, where applicable, which documents / forms you have submitted to University Programs from the list below

Résumé / curriculum vitae*

Yes
No
N/A

Transcripts*

Yes
No
N/A

Release and assumption of risk form*

Yes
No
N/A

Medical / health insurance waiver*

Yes
No
N/A

Media release form*

Yes
No
N/A

BIOS general behavior policy*

Yes
No
N/A

Drug-free workplace waiver*

After reviewing the drug-free workplace policy statement

Yes
No
N/A

Color copy of passport ID page*

Yes
No
N/A

Color copy of multiple re-entry visa (MRV)*

If required for entry into Bermuda

Yes
No
N/A

PRC card / certificate*

Yes
No
N/A

U.S. financial information form*

Yes
No
N/A

W-4 form*

Yes
No
N/A

Student diving information packet*

Yes
No
N/A

Upload files

If required, upload your files here or email them to bios.education@bios.asu.edu.

Drop files here or

Max. file size: 100 MB.

Further Information and Consent

Please use this space to provide any additional information

Consent*

I give permission for my primary email address to be included in a distribution group within the BIOS email network and added to the University Programs contact list