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.?

YesNoI don't know
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:*

Visitor has citizenship or residency in an English-speaking countryScholar has a degree or transcript from a program taught in EnglishI have interviewed or had in-depth interactions with the scholar (by telephone, in person, or by video conference)Visitor has submitted valid evidence of an English-proficiency test result (above 90 iBT, 6..5 IELTS)
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.*

Teaching course (include name of course below)Guest lecturing in course(s) (indicate below)Public lecture for Smith communityDepartmental meeting/lectureIndividual/group meeting(s) with studentsOther (describe below)
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)

Smith College guest housing-Dependent upon availabilty, not guaranteedHonorarium (please indicate amount below)No more than $750Library privileges for the length of the visitOther
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.*

Upload a File

Cancelof
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.
Should be Empty:

International Visitor/Scholar Request Form

Section 1 - Visitor Information

Section 2 - Host Information

Section 3 - Visitor Resources & Funding

Form Submission