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Scholars In Prison

Student Advocacy Seminar

INVITE A SPEAKER

Monitoring Attacks

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Apply for Assistance

If you are a scholar experiencing threats to your life, liberty or academic career, or if you have been forced to leave your country because of such threats, and would like to request help from SAR please complete and submit the form below.

Instructions:

1. Fill out the form. All fields with an asterisk (*) are required...

2. Click "confirm information"... (The page will turn grey.)

3. Review the information provided. If the information is correct...

4. Scroll to the bottom of the page and click "submit."

(You must click "confirm" AND "submit" for your information to be received).

If you encounter any problems submitting this form, you can also send a message to Scholars at Risk via our contact form.

Confidentiality: Information provided is treated as confidential and used only for the purpose of arranging help where possible, including visits to SAR Network member institutions. If you prefer not to use the online form, you may print and mail or fax it, or contact Scholars at Risk by telephone.


Step One: Complete Form Security

Is it safe for Scholars at Risk to contact you directly about your situation?

Yes. Please contact me directly.
No. Direct contact is not safe at this time. Please contact me through:
 

Personal Information

Title / First Name *
Middle Name
Last Name *
Phone *
Mobile
Email *
Address
Address (cont.)
Address (cont.)
City
State/Province
Postal Code
Country *
M/F
Date of Birth
 
Marital Status
Nationality
Languages: Please list the languages in which you teach, research or conduct your work:











 

Academic / Professional Information

Field / Discipline
Specialization
Highest Degrees
Degree type
Subject
Institution
Location
Start Date
End / Award Date
Employment
Institution / Organization
Location
Position
Start Date
End Date
 

Threat or Risk Information

Please indicate your current location:*
Please describe the threats or risk you are experiencing and the help you are requesting from Scholars at Risk: *
 

Help / Opportunities Sought

Timing Requested
Opportunities sought:
Not Seeking
Seeking 1-3 month teaching
Seeking 3-6 months
Seeking 6-12 months
Seeking co-teaching
Seeking research
Seeking graduate study opportunity
 
Submitted by (if other than applicant)
Name
Email / Phone Number
 
  
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