International Visitor/Scholar Request Form

International Visitor/Scholar Request Form
Form Submission Date:

MonthDayYear
What are the proposed dates for this visit?
Section 1 - Visitor Information
Name of Visitor:

First NameLast Name/Surname
Visitor's Mailing Address:
Email Address of Visitor:
Visitor's Home Institution:
Visitor's Academic Field (including specialties):
Are they currently in the U.S.?
Country of Citizenship:
Country of Residency:
What type of visa does the visitor need?
Please note that any visitor staying longer than 9 days and receiving compensation of any kind (i.e.: honorarium, housing, airfare, meals, etc) is required to enter the United States on a J-1 Visitor Exchange visa and may be subject to Export Control regulations. For more information on visas, please contact Caitlin Szymkowicz, Associate Dean of International Students and Scholars, cszymkowicz@smith.edu.
Is the visitor proficient in English?
All J-1 exchange visitors must have sufficient English proficiency in order to to fully participate in any Smith position, understand their rights as a visitor, and function in the U.S.
If yes, please confirm how this has been determined:
Has the individual been a visitor to Smith before? If so, when?
Please check the activities the visitor would be involved in during the visit.
Additional Details - Visitor Activities (courses, other):
Section 2 - Host Information
Name of Faculty Host:

First NameLast Name
E-mail of Faculty Host:
Faculty Host's Department or Program:
Example: ART, GOV, PSY, etc.
Name of Faculty Host's Chair/Director (if applicable):

First NameLast Name
E-mail of Faculty Host's Chair/Director (f applicable):
Name of co-hosting department's Chair/Director (if applicable):

First NameLast Name
E-mail of co-hosting department's Chair/Director (if applicable):
Name of Department Academic Assistant:

First NameLast Name
Email Address of Department Academic Assistant:
Name of co-hosting department's Academic Assistant (if applicable):

First NameLast Name
E-mail of co-hosting department's Academic Assistant (if applicable):
Section 3 - Visitor Resources & Funding

Please note that any visitor staying longer than 9 days and receiving compensation of any kind (i.e.: honorarium, housing, airfare, etc) is required to enter the United States on a J-1 Exchange Visitor visa and may be subject to Export Control regulations.
What funding sources are available to assist with this visit? Please indicate the source, amount and what use they are intended for (i.e.: honorarium, airfare, housing, etc).
Are there additional benefits being requested from the Visiting Scholars Fund*? (Check all that apply)

Other
Honorarium amount:
Please provide a brief paragraph which explains the specific intellectual and academic justification for this visit.
Please attach a copy of the visitor's CV.

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Form Submission
Note: Once submitted, you will receive a copy of your form via email. A copy of your form will also be sent via email to the Chair/Director of your Department/Program, the Academic Assistant for your Department/Program, and any partnering Chairs/Directors and Academic Assistants.
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International Visitor/Scholar Request Form

Section 1 - Visitor Information

Section 2 - Host Information

Section 3 - Visitor Resources & Funding

Form Submission