Distinguished Visiting Scholar Application Form Distinguished Visiting Scholar If you are human, leave this field blank. 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 Bosnia and Herzegovina Botswana Bouvet Island Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Côte d'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea 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 Norway Northern Mariana Islands Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Yemen Zambia Zimbabwe Country Best mailing address for Distinguished Visiting Scholar Candidate. Attach CV * Uploading Files. Please Wait. 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.
