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 * Arts & Sciences Brown School Olin Business School Sam Fox School of Design & Visual Arts School of Engineering & Applied Science School of Law School of Medicine The Graduate 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 Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Best mailing address for Distinguished Visiting Scholar Candidate. Attach CV * Drop a file here or click to upload Choose File 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 * Drop a file here or click to upload Choose File Maximum upload size: 16MB Upload letter or email of support from your dean or department chair. If you are human, leave this field blank.