Tinker-Nave Visiting Scholar and Artist Application

Name of individual submitting this application*

First Last

Submitter's Email Address:*

Name of Speaker:*

Presenter's Email Address:*

Please note that we will utilize the presenter's email address in order to send him/her a survey through our Travel and Management Software System (TEMS). Through this portal, he/she can securely send confidential information needed to process his/her honorarium payment.

Title of Public Presentation/Lecture:*

If unknown when submitting application please just enter "TBA".

Date of Arrival*

Date of Departure*

Initiating Faculty Member/ Department/Organization:*

Contact information of person responsible for local arrangements for speaker:*

Please include name and phone numbers

Proposed schedule of lectures and other activities:*

Please give specific information, including leacture titles, dates and room locations if available.

Can we videotape this presenter?*

Yes
No

At times, we will videotape presentations. These videos will be uploaded to the LACIS YouTube Channel and may appear on local access cable programming.

Will any of the speaker's events contribute directly to course enrichment? If so, please explain:*

Be sure to identify the course, and to indicate whether the speaker will visit or establish contacts in any way.

If the event will benefit groups beyond the sponsoring unit(s), please indicate who these groups are:

Has this speaker appeared on campus within the last three years?:*

If so, describe the events, date, attendance and public or intellectual impact.

Outreach and Organizing Plans:

Will the visitor's lectures, etc. be conducted in English, Spanish, Portuguese, or something else?*

If the events will not be conducted in English, will a translator/interpreter be provided?

Budget Sharing

Please provide details about sources of additional funding for this visit:*

Due to the high volume of requests for NAVE Visiting Scholar funds, preference is given to applicants who have applied for or received funding from other sources. Please provide detailed, categorized (honorarium, travel, lodging, etc.) information about all additional sources of funding. In the event that complementary funds have not been sought, please explain why.

Budget for Funds Sought:

Because of heavy demand for Nave Visiting Scholar and Artist funds, applications with another source of funding will receive preference.

Honorarium Request from LACIS*

Travel Request from LACIS*

Lodging Request from LACIS*

For more information about current State reimbursement rates, please visit: https://businessservices.wisc.edu/documents/3017-2-determining-lodging-maximums-procedure/

Total Request from LACIS*

Documents

Abstract*

Accepted file types: pdf, doc, docx, Max. file size: 2 MB.

If time permits, please submit a short (1-2 paragraph) abstract summarizing this visit. Files must be less than 2 MB. Allowed file types: pdf doc docx.

Additional Attachments

Drop files here or

Accepted file types: gif, jpg, png, pdf, doc, docs, ppt, pptx, xls, xlsx, movmp3, wav, Max. file size: 2 MB.

Please attach any additional support documents you wish here. Files must be less than 2 MB. Allowed file types: gif jpg png pdf doc docx ppt pptx xls xlsx mov mp3 wav.