Department of Social Science, Health & Medicine
Visiting Application Form
To apply to be a visitor at the Department of Social Science, Health & Medicine,
King’s College London, please complete this form. You should have an agreement in
principle from a member of the Department of Social Science, Health & Medicine
staff to act as your sponsor/supervisor while at King’s. Once completed, please
submit this form to your prospective sponsor/supervisor so that a supporting
statement can be provided.
Your application will then be considered by the Department Research Committee. Please note that having
an agreement in principle from a member of staff to supervise you does not guarantee that you will be
accepted by the Department Research Committee.
Please complete this form in BLOCK CAPITALS.
Personal details
Surname/Family name
First name(s)
Title (eg Mr, Ms, Dr)
Date of birth
Address
Email address
Telephone number(s)
Nationality
Country of birth
Country of permanent residence
In which country are you currently living?
Funding
Please tell us how you are planning to fund your fees and living expenses for the duration of your visiting
research:
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Sponsorship
Proposed sponsor within SSHM
Proposed dates of attendance at King’s
Visiting Professor
Visiting Senior Lecturer
Visiting Lecturer
Visiting Senior Research Fellow
Visiting Research Fellow
Visiting Postdoctoral Fellow
Visiting Research Associate (please fill in “Details of
previous study” section)
Visitor status applying for
Details of previous study – for Visiting Research Associates
Institution of current study
Date started MPhil/PhD
Proposed supervisor at King’s
Proposed dates of attendance at King’s
Previous qualifications
Please provide details of your previous university-level study
Institution
Dates
attended
Title of programme/field of study
Qualification and
result
English language proficiency
Please select one of the following statements:
I have been taught and examined in English for my entire education to date
I have been taught and examined in English for part of my education to date
(Please state most recent period
)
If you have taken a specific English language test, please state here:
Candidate number:
Score achieved:
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Short outline of project to be undertaken at King’s
Please write no more than 750 words. The outline should include an explanation of why your research
would benefit from being located at the Department of Social Science, Health & Medicine, how you would
expect to contribute to the Department, how often you would be here, and what resources you would need.

Research Proposal

Why SSHM and King’s College London?

How would you contribute to the department?

Timing and duration of visit (please also state how much time you intend to spend physically in the
Dept)

Resources required
Research Groups
Please indicate which Research Group you are applying to belong to during your visit

Ageing & Society

Biomedicine, Ethics & Social Justice

Biotechnology, Pharmaceuticals & Public Policy

Culture, Medicine & Power
(further details)
(further details)
(further details)
(further details)
Give a brief explanation of why your research fits within this group:
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Curriculum Vitae
Please include here an up-to-date CV with this application form. Please limit your CV to two sides of A4.
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Queries
If you have any queries contact susan.chandler@kcl.ac.uk
Declaration
When you sign the declaration on the application form, you agree that King's College London can process
your information and keep a copy of your form to collect statistics and detect and prevent fraud. The Data
Protection Act allows you to ask for a copy of all the information we have about your application.
I confirm that the statements made by me on this form are correct. I understand that if any of the above
statements prove to be incorrect the College reserves the right to withdraw any offer made or cancel any
subsequent registration with the College. I have read the guidance notes; I undertake to be bound by the
terms set out in them and I give my consent to the processing of my data by King’s College London.
King’s College London reserves the right, at any time, to request that you, your referees, or your employer,
provide further information relating to any part of your application form, e.g. proof of identification, of
status, of academic qualifications and/or employment history.
Any offer of a place that you may receive is made on the understanding that, in accepting it, you agree to
abide by the rules and regulations of King’s College London.
Signed................................................................................. Date..................................................................
PROSPECTIVE SPONSOR SUPPORTING STATEMENT
Signed................................................................................. Date..................................................................
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