VISITING SCIENTIST/RESEARCH AFFILIATE Forms: English Proficiency Your Name and Email(Required)Name of Host PI(Required)Scholar Info:Scholar Name(Required)Scholar Email(Required)CitizenshipWill the Scholar Need a Visa?(Required) Yes No Unsure MIT ID if previously assignedAppointment Info (can be modified post submission as circumstances warrant): Start and end date(Required)If visa is required, the start date will be dictated by the visa program. The start date can be the 1st or 16th of the month.Appointment % Effort(Required)How many days will the scholar be on campus?MIT Funding Amount, If AnySource of funds (cost object(s), fellowship, self-funded)(Required)What is the proposed purpose of MIT appointment? (Please provide a 3-4 sentence summary of research and connect to active sponsored project if applicable)(Required)Where is the Visitor/Research Affiliate employed and in what position?(Required)VPR Conflict of Interest Questions - To Be Answered by Faculty. These Are Required For All Incoming Visitors 1. Does faculty host have a personal relationship with the visitor? (e.g. are they related, did they know each other beforehand, or previous Grad/Postdoc supervisor):(Required) Yes No If yes, please describeDescription, question 1(Required)2. Does faculty host or member of the faculty host’s family have outside professional/significant financial interest (SFI) with visitor’s employer? (e.g. consulting, board membership, ownership)?(Required) Yes No If yes, please describeDescription, question 2(Required)3. Will any company or company-related research be carried out by the visitor while on campus?(Required) Yes No If yes, please describeDescription, question 3(Required)4. Describe the research at the visitors home institution? Describe the research that will be done at MIT? Describe how the two are separate and distinct?(Required)5. Is the visitor coming to MIT under an existing Sponsored Research Agreement?(Required) Yes No If yes, what is the cost object and project title?Cost object and project title(Required)6. Will the visitor bring any materials to campus (e.g. software, databases, biological materials)?(Required) Yes No If yes, please describe.Description, question 6(Required)Attachments: CV, English Proficiency form if visa needed (link to blank English Proficiency Form can be found at the top of this application)(Required) Drop files here or Select files Max. file size: 580 MB.
