U.S. Tax Law

Enrollment Form

First Name *
Paternal Last Name *
Maternal Last Name *
Gender: How do you describe yourself?

Gender: How do you describe yourself? Male Female Nonbinary Different Identity (Self Identify _______)
Date of Birth Date of Birth * / MM / DD YYYY
City of Birth *
Country of Birth *
Country of Citizenship *
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Company *
Work Address Work Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Phone *
Fax Fax - ### - ### ####
Other
How did you learn about the Program? *

How did you learn about the Program? Employer Supervisor Professor/University Staff Friend Website Other
Are you interested in the UC San Diego Package (Modalidad 1) or Independent Package (Modalidad 2)? *

Are you interested in the UC San Diego Package (Modalidad 1) or Independent Package (Modalidad 2)? UC San Diego Package (Modalidad 1) Independent Package (Modalidad 2) I am not sure yet; please provide more information.
If you know your duration of the stay in the U.S., please enter the dates below (you may enter approximate dates).
Entry Date Entry Date / MM / DD YYYY
Departure Date Departure Date / MM / DD YYYY
Do you have any dietary restrictions (vegetarian, vegan, etc.) or food allergies? If so, please describe.
Current resume or CV *

Attach Files
By signing your full name here, you certify that all information on this application is true and complete. *

Draw or Type

Clear

Full Name

U.S. Tax Law

U.S. Tax Law

Other

If you know your duration of the stay in the U.S., please enter the dates below (you may enter approximate dates).