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Visiting Scholar Application

Before submitting the Visiting Scholar Application, please be certain that you have:

Personal Data (Please print or type)

Name (first middle last):____________________________________________

Current Address (street, state, zip):__________________________________
_________________________________________________________________

Current Address effective until:________________________

Current Telephone Number: (____)_____________________

Permanent Address (street state zip):_________________________________
_________________________________________________________________

Permanent Telephone Number: (_____)_________________

Fax: (_____)_______________

E-mail: ____________________________________

Please list the dates for which you are considering visiting (1 week minimum, 9 months maximum): __________________________________________________

Please list the topic(s) you will deal with at WATER_________________________________________________________________
_______________________________________________________________________

Languages spoken: ____________________________________________________

Special skills you would like to mention:________________________________
_________________________________________________________________
_________________________________________________________________

Extra Curricular and Community Activities:______________________________
_________________________________________________________________
_________________________________________________________________

College/University/ReligiousOrganization/Other

Name____________________________________________________________________

Address__________________________________________________________________

Telephone Number (____)________________________

Fax (____)____________________________________

E-mail:_______________________________________

Essay

Please include a typewritten essay which describes: 1) Your background and related experience; and 2) Your overall personal goals for the Visiting Scholarship, including the issues or concerns on which you wish to work while at WATER. Indicate with whom at WATER you would like to work. Please limit your essay to two double-spaced pages.

Emergency Contact Person:

Name:______________________________________________________________
first last

Address:____________________________________________________________
street state zip

Telephone Number: Day (____)______________

Night (____)________________

Fax: (_____)______________________ E-mail:____________________________

Visiting Scholar Agreement

I understand that the Visiting Scholar Application, plus all supporting materials submitted to WATER, will not be returned or transferred to other institutions or potential employers. I certify that the information provided is complete and accurate. I understand that housing, meals, travel and miscellaneous expenses will be my responsibility.

__________________________________________________

Signature/Date

Letters of Recommendation

Please supply WATER with two letters of support for your application from colleagues or supervisors.

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