Visiting Scholar/Honorary Fellow Request Form Visiting Scholar/Honorary Fellow Request Form Thank you for your interest as a visiting scholar or honorary fellow in the Department of Asian Languages and Cultures at the University of Wisconsin - Madison. To better assist us, please provide the following information. Family Name*Given Name*Date of Birth* Date Format: MM slash DD slash YYYY Proposed Start Date* Date Format: MM slash DD slash YYYY Proposed End Date* Date Format: MM slash DD slash YYYY Email Address* Address Line 1*Address Line 2Address Line 3City/Province*Country*Postal CodeProfessor you are requesting to work with*Highest Degree Earned*Bachelor'sMaster'sPhDPostdoctoralBriefly describe your research proposal (2-3 sentences)*If invited as a visiting scholar/honorary fellow, would you be willing to take part in a language exchange with current undegraduate students?*YesNoCurriculum Vitae*Research Proposal*