Please use the Tab key to move from field to field. Click Submit or press the Enter key when you are ready to send the form.

Proposed Period of Stay at the Institute

(Program available only September – May)

From: mm/dd/yyyy

TO: mm/dd/yyyy

Personal Information

First Name

Middle Name

Last Name

Home Address

City/Province

State/Country

Zip Code

Home Telephone

Present Professional Position

Fax

Business Address

City/Province

State/Country

Zip Code

Business Telephone

Preferred Mailing Address

Email Address

Date of Birth

Country of Birth

Country of Citizenship

Gender

Religious Affliliation

Marital Status

Name of Spouse

Spouse at Institute

Names of Children

Child 1

Date of Birth (MM/DD/YYYY)

Gender

At the Institute

Child 2

Date of Birth (MM/DD/YYYY)

Gender

At the Institute

Child 3

Date of Birth (MM/DD/YYYY)

Gender

At the Institute

Child 4

Date of Birth (MM/DD/YYYY)

Gender

At the Institute

3. Proposed Project
(Please send as attachments in a separate email to staff@collegevilleinstitute.org)

A typed statement of the work project you propose to pursue at the Institute. The statement should be in three parts:
* TITLE, 20 words maximum;
* PRECIS of the project, 100 words maximum;
* DESCRIPTION of the project, 1000 words maximum.

4. LETTERS OF RECOMMENDATION

It is the responsibility of the applicant to request one letter of recommendation to be sent to staff@collegevilleinstitute.org with the name of the applicant in the Subject line of the email. List the names and addresses of your recommender below:

Name 1

Address 1

5. SHORT-TERM RESIDENCY FEES
One week - $ 350 Two weeks - $ 630 Three weeks - $ 840 Four weeks - $1,120
Five weeks - $1,225 Six weeks - $1,470 Seven weeks - $1,715 Eight weeks - $1,680

The residency fee includes furnished apartment and access to facilities at St. John's University, including Alcuin Library. This fee does not include meals although a food plan can be arranged with St. John's Dining Service.

By clicking accept below, you testify both to the accuracy of the information provided, and to your guarantee that if invited to become a short-term resident scholar, you will have sufficient financial resources to cover the residency fee and to meet expenses for yourself and any dependents living at the Institute. By clicking accept, you testify that you and your family are covered by a health insurance policy.

Accept Terms and Conditions

For applicants from abroad, by clicking accept above also testifies to the following statement:
"If invited to be a short-term resident scholar and I accept the invitation, I (and any dependents who accompany me) will be covered by health insurance meeting the requirements established by the Bureau of Educational and Cultural Affairs of the United States Department of State for participants in an Exchange Visitor Program. This insurance will be provided through a policy issued (check one):

Insurance

Other Insurance Provider

Comments/Additional Information or Questions