Distinguished Visiting Scholar Application Form

Distinguished Visiting Scholar

Faculty Contact Person

Name of Faculty Contact *

Email Address *

Phone Number *

Campus Box *

Campus Box of faculty contact.

Primary Hosting School/Department Information

School *

Department *

Co-sponsoring Departments/ Programs

List all co-sponsoring department (s)/ programs (s)/ speaker series/ conference(s) or external agencies. Type "none" if there are no co-sponsors.

Staff Contact Person

This should be the name of the staff member who would provide primary administrative and or planning support should funding be approved.

Name of Staff Contact *

Email Address *

Phone Number *

Campus Box *

Distinguished Visiting Scholar Candidate Information

Full Name (Candidate) *

Full name of Distinguished Visiting Scholar Candidate

Title *

Title (s) of Distinguished Visiting Scholar Candidate:

Field of Specialization *

Field of Specialization of Distinguished Visiting Scholar Candidate

Institution *

Primary University / Institution of Distinguished Visiting Scholar Candidate

Email Address *

Email address of Distinguished Visiting Scholar Candidate

Website/URL *

Website/ URL Distinguished Visiting Scholar Candidate

Address

City

State/Province

Zip/Postal

Country

Best mailing address for Distinguished Visiting Scholar Candidate.

Attach CV *

Maximum upload size: 16MB

Upload most recent CV of Distinguished Visiting Scholar Candidate

Proposed Start Date of Visit *

Proposed End Date of Visit *

Activities for Faculty *

Activities for Students *

Include all activities in which undergraduate/ graduate/ professional students will be involved in the visit.

Estimate of Costs *

Costs covered include stipend, airfare, hotel (room only) and official meals/events involving Washington University in St. Louis faculty, staff and students.

Letter of Support *

Maximum upload size: 16MB

Upload letter or email of support from your dean or department chair.

If you are human, leave this field blank.