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Show APPLICATION FOR DSP-66 ' ^Il INTERNATIONAL STUDENT SERVICES Bldg. kl UofU In order to process a DSP-66 for the exchange visitor coming into your department, complete the information required on this form and return it to the office of International Student Services. If you have any questions relating to the required information call 8876. 1. Department and individual requesting the DSP-66: Phone 2. Name of exchange visitor na g/j j g] _J _>.I r A L_! MaleZZ/Female O 3. Birthday ___l3___-_f__Z3 city ____f_______----2 Country l»cjid\. k. Legal permanent resident of what country / A/J)? A 5. The person's position in that country is f\t/tVegt Ai _' /fg^£>r _________* <"v _. __:4 _!___.? st ''rf _____________ (if the person works in research, state whether the work is for a university a government or in private industry. If the person works for the government, state if it is at the city, regional or federal level.) 6. Visa application to cover initial period ] _j__ • ' / 79 to 'v , ' (date) >£ />u\Yci 5C> . (Granted only for one year at a time) (date) •• • 7. Visitor will be categorized as: EJstudent EJtrainee ZZ7teacher / ZZ7professor Z_7research scholar or specialist EJinternational visitor f~lprofessional trainee 8. The visitor will be engaged in the following activity ^j_^_j__^___ A .^ ---•"-------•--•---------- (example: Research Associate in" organic chemistry.) 9. During the period of the visitor's stay, the following estimated financial support will be provided by: EJ University of Utah $ O U.S. Govt. Agency $ (name) EJ International Organization $ " (name) EJ The visitor's government $ El Other agencies or organizations $_ O T T - _ 1 - ^ (name) A Visitor's personal funds $ |