International Fellows/Visiting Scholars
International Fellows/Visiting Scholars
Fields denoted by an asterisk (
*
) are required.
Host department:
*
Main department contact:
*
Email address:
*
Visitor Information
Name
Name
*
First
Last
Home Country:
*
Home University/Hospital:
*
Reason for visit to the Schulich School of Medicine & Dentistry: (choose one of the following)
*
Research
Training
Teaching
Other
Please specify the "Other" reason for visit to the School:
*
Time period at the Schulich School of Medicine & Dentistry:
Arrival Date:
Arrival Date:
*
/
MM
/
DD
YYYY
Departure Date:
Departure Date:
*
/
MM
/
DD
YYYY
Other comments: