<p> Application for Admission</p><p>Twenty-fifth National Security Law Institute 2017 Session: Sunday, June 4 – Friday, June 16</p><p>Page 1 of 3</p><p>APPLICATION DEADLINE: Wednesday, 10 May 2017</p><p>Please type or print clearly</p><p>1. NAME: First Middle Family</p><p>2. PRESENT MAILING ADDRESS: Street Address</p><p>City State (USA) or Country Postal Code</p><p>EMAIL ADDRESS: ______</p><p>3. PERMANENT MAILING ADDRESS: </p><p>4. CURRENT ORGANIZATION: ______</p><p>5. CURRENT POSITION: ______</p><p>6. PROFESSIONAL EDUCATION: ______Application for Admission</p><p>Twenty-fifth National Security Law Institute 2017 Session: Sunday, June 4 – Friday, June 16</p><p>Page 2 of 3</p><p>7. CITIZENSHIP: U.S. Citizen Permanent Resident  Non-resident :</p><p>8. CURRICULUM VITAE: Please attach a resumé or curriculum vitae indicating educational background (including any honors awarded), related work experience and current position and title (including a description of duties), and any other information you feel is relevant to your application. </p><p>9. HEALTH: The Center for National Security Law cannot assume responsibility for any medical expenses incurred by an individual while attending the Institute. Therefore, applicants who are accepted to the Institute must have health insurance coverage. This is not a prerequisite for applying. Applicants to the National Security Law Institute must accept full responsibility for their health and related expenses while in Charlottesville, VA.</p><p>10. LANGUAGE REQUIREMENT: All courses at the National Security Law Institute will be taught in English.</p><p>11. TUITION: The attendance fee for the NSLI is $1950, which includes:</p><p> Daily lectures  Course materials, including textbooks  Daily lunches and two evening events  Twelve (12) nights of lodging at The Hyatt Place at Stonefield; starting Sunday, June 4 through Thursday, June 15, 2017 (Complimentary breakfast included in room rate)</p><p>12. SCHOLARSHIPS: The Institute does offer financial scholarships on an as-needed basis. For information regarding scholarships, please contact Bill Lacy, [email protected] Application for Admission</p><p>Twenty-fifth National Security Law Institute 2017 Session: Sunday, June 4 – Friday, June 16</p><p>Page 3 of 3</p><p>For more information about the Institute, the points of contact are: </p><p> Program Information: Ms. Mer McLernon, [email protected] or 434-924-4771  Application: Mr. Bill Lacy, [email protected] or 434-924-3590 </p><p>Signature of Applicant (electronic signature or initials may be used)</p><p>______</p><p>Date: ______</p><p>Please email this completed form (THIS APPLICATION FORM MUST BE SAVED IN MICROSOFT WORD) to: </p><p>Submit Application to: Bill Lacy: [email protected] </p><p>Bill Lacy Center for National Security Law University of Virginia School of Law 580 Massie Road, Rm. 350 Charlottesville, VA 22903 </p><p>Phone: (434) 924-3590 Fax: (434) 924-7362 http://www.virginia.edu/cnsl/nsli</p>