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FIRST NAME LAST NAME
Nationality Country of Residence
Date of Birth(mo/day/yr) Sex F M
Married NO YES
Will your spouse accompany you?
NO YES
Ages of children accompanying you:
DEAF?: NO YES Do you use sign language? NO YES

INFORMATION ABOUT YOURSELF: (Hobbies, interests, etc.)

DIETARY RESTRICTIONS: (e.g. vegetarian, allergies)

How long do you expect to stay in Rochester? Month/Year of Arrival
Name of School Degree Expected(BS,MS,PhD)
Department/Program

CURRENT ADDRESS: Please provide contact information at which you can be reached from now until your arrival in Rochester.

Current Phone Number Current Fax Number

Rochester Address (if known):

Rochester Phone Number Rochester Fax Number  

E-MAIL


 

Rochester International Council
Morey Hall, Room 229, University of Rochester Rochester, NY 14627 USA

phone (585) 275-8779 fax (585) 756-8086
e-mail: jw@rifc.org
Office Hours: 10:30 am to 5:00 pm Eastern Time, Monday-Friday,
closed Thursday