Studium: Visiting Scholars Program Application

Fill out this form, which will be submitted to the Director of Studium.

I am applying for the following program: *
 Resident Scholar
 Day Scholar
Name: *
Address *
Phone (work)
Phone (home)
Phone (cell)
E-mail address *
How long do you wish to be a Visiting Scholar (applications may be for a week to four months)? What are your preferred dates (if there are options, please indicate)? *
Do you have any special needs (dietary, other)? *
Please list the name, address (including e-mail if possible), and phone number of one person who can provide a professional reference for you. *
Please list the name, address (including e-mail if possible), and phone number of one person who can provide a personal reference for you. *
Brief description of your project:
Please attach a copy of your curriculum vitae with this application. (Click on "browse" to find and attach file from your computer.) *
Submission of this application implies that you are able to pay the Studium fee (Resident Scholar: $350/week, $1250/month; Day Scholar: $75/month). If accepted, you will be expected to send 1/3 of the total fee (non-refundable) to confirm your place.