Form

Affiliate Application

Please complete the following form to apply for CCPR affiliation.
Name*
Department*
E-mail*
Request Type*

Faculty Affiliate Student Affiliate

Advisor and Funding
* Student affiliates must be sponsored by a current CCPR faculty affiliate. This sponsor must be the student's primary advisor or a member of their graduate committee or the student must work for the sponsor. Sponsorship will be verified prior to affiliation approval.

For a list of current faculty affiliates please see CCPR Faculty .
CCPR Faculty Sponsor*
Sponsor E-mail*
Advisor*
Funding Source*

RA/TA Fellowship Grants Other
Other Funding*
Previously Earned Degrees
Degree*
Year Graduated*
Major or Area of study*
School or Educational Institution*
Degree
Year Graduated
Major or Area of study
School or Educational Institution
Degree
Year Graduated
Major or Area of study
School or Educational Institution
UCLA Graduate Program
Year Entered UCLA Graduate Program*

Research Interest*
Please provide a paragraph detailing how your interests comply with broadly defined demography.
CV*
Recent Photo
I give permission to CCPR to use my photo on the CCPR website*

Yes No
Should be Empty:

Affiliate Application