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*
MM slash DD slash YYYY
Gender*
Proposed Start Date*
We strongly recommend that Honorary Fellows use a Proposed Start Date of the 15th of the month and a Proposed End Date of the 14th of the month. Coverage for the required health insurance for international scholars begins on the 15th of the month and ends on the 14th of the month. Proposing a different start date will result in the Honorary Fellow being charged for an additional two months of coverage.
MM slash DD slash YYYY
Proposed End Date*
MM slash DD slash YYYY
Email Address*
Address Line 1*
Address Line 2
Address Line 3
City/Province*
Country*
Postal Code
Professor you are requesting to work with*
Highest Degree Earned*
Briefly 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?*
- Yes
- No
Curriculum Vitae*
Max. file size: 24 MB.
Research Proposal*
Max. file size: 24 MB.
Comments
This field is for validation purposes and should be left unchanged.