International Visit Planning Form

Please submit the form below with your draft itinerary a least 6 months prior to visitation if a visa request is required from the University Center for International Education. If it is determined that a visa is not required, submit the form a minimum of 1 month prior to the visit to ensure institutional participation and support.

Current date

Month

Day

Year

Visit Dates

Start date Required

Month

Day

Year

End date Required

Month

Day

Year

Visitor information

Nature of visit

Objective and expected outcomes of visit

Delegation leader

Name

Title

Address

City/Province/State

Country

Office number

Cellular number

Skype contact

Website address

Affiliation/Home Institution

Home city

Home country

Additional Visitors

Visitor 1

Name

Title

Phone

Visitor 2

Name

Title

Phone

Visitor 3

Name

Title

Phone

Visitor 4

Name

Title

Phone

Visitor 5

Name

Title

Phone

Wright State Visitor/Delegation Point of Contact

Name

Title

Phone

Local Contact Information for Visitors

Local address during visit

Hotel or Other Host Details

Name of hotel or host

Address

Phone

Fax

Host Contact at Wright State

Host Information

Name

Address

Phone

Cellular

Fax

Host college and/or department

Media request for visit, please list here

Budget for visit including funding sources

Upload final itinerary for visit here

Files must be less than 5 MB.
Allowed file types: pdf doc docx.

Wright State Participants Information

Select potential participants at Wright State

Wright State President*

Wright State Provost*

College Dean

Other...

Select potential participants at Wright State Other...

*These administrators require College Dean or Vice President Approval. A notice will be sent to host’s Dean or Vice President automatically and will be verified by the University Center for International Education.

Additional Wright State Participants

Participant 1

Name

Title

Participant 2

Name

Title

Participant 3

Name

Title

Participant 4

Name

Title

Participant 5

Name

Title

Contact Information

For futher information and assistance with planning for the international visit to Wright State, please contact:

William Holmes, III, MA
Associate Vice President
Center for International Education
Wright State University
Student Union 186
3640 Colonel Glenn Hwy.
Dayton, Ohio 45435-0001
(937)775-5745
askucie@wright.edu

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