Distinguished Visiting Scholar – Global Distinguished Visiting Scholar – Global Faculty Contact Person Name of Faculty Contact * Name of Faculty Contact First First Last Last Email Address * Phone Number * Primary Hosting School/Department Information School * Arts & SciencesBrown SchoolOlin Business SchoolSam Fox School of Design & Visual ArtsSchool of Engineering & Applied ScienceSchool of LawSchool of MedicineThe 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 * Distinguished Visiting Scholar Candidate Information Full Name (Candidate) * Full Name (Candidate) First First Last Last 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 Country of the candidate’s home institution/residence * *If an international candidate is already in the U.S. or will be visiting from a country other than that of the home institution, please note this here. 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 AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Best mailing address for Distinguished Visiting Scholar Candidate. Attach CV * Drop a file here or click to upload Choose File Maximum file 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. Which of the following activities will the scholar engage in during the visit? * Presentation/lecture/seminar Workshop/conference Classroom visit/student engagements Exhibit/performance Meetings with current/prospective collaborators Training/academic/cultural exchange Engage in collaborative project Review/collect data Prepare manuscript/publication/grant proposal Observe laboratory/clinical facilities/other specialized resources Interact with patients OtherOther *Select all that apply. 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 file size: 16MB Upload letter or email of support from a faculty member, dean or department chair. Acknowledgement of discussion with department chair/dean. * I acknowledge that I have discussed the potential visitor with my department chair or dean and that my department is committed to facilitating this visit. Captcha If you are human, leave this field blank. Δ