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Visiting Research Scholar Application Form
| Last Name | First Name | Middle Initial |
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| Address ____________________________________ ____________________________________ ____________________________________ Citizenship ___________________________ |
Home telephone ________________________ Work telephone _________________________ Fax __________________________________ E-mail ________________________________ |
| Date of birth ______________ (dd/mm/year) | Sex ____________ (Male/Female) |
| Title and Institutional
Affiliation
___________________________________________________ Proposed length of fellowship (six months, one academic year, other) ___________________________ Field of Study ________________________________________________________________
References: (Name, Title and Name of the Institution of each referee. One should be from the professor you are currently working with.) 1) ___________________________________________________________________________________ 2) ___________________________________________________________________________________ 3) ___________________________________________________________________________________ |
| Research Information: Title of Project ________________________________________________________________________ _______________________________________________________________________________________ Research description, it's goals and significance, 500 words. (approx. 2 pages double-spaced) Use separate sheets and attach them with current application.
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| Education: |
| Date | Institution | Major Field | |
| 1)
_________________________________________________________________________________ 2) _________________________________________________________________________________ 3) _________________________________________________________________________________ Other ________________________________________________________________________________ |
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| Experience: (most recent first) |
| Date | Organization | Position |
| _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ |
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| Fellowships/Honors/Awards: (most recent first) |
| _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ |
| Language: (If English is not your native language, indicate your degree of fluency in English, using Excellent, Good, Fair, or Poor.) |
| Reading | Speaking | Writing |
| Acknowledgement:
By signing below, I certify, that all information provided above and in
the supporting documents is complete and accurate. ________________________________________________________________________________________ Date Signature of an Applicant |
Mail to:
2033 K
Street NW, Suite 240
Washington, DC 20052
Attn: Ms. Wafa Abou-Zaki
or Contact:
TEL: (202) 994-1681
FAX: (202) 994-5284
E-mail: waz@gwu.edu
