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Scholar Service Request Form

Information in BOLD is required.

Scholar Information

  1. Full Name:
  2. Gender:
  3. Date of Birth: (MM/DD/YYYY)
  4. Country of Birth:
  5. VISA Type:
  6. Mailing Address:
  7. Email Address:
  8. Fax Number:

Sponsoring Department's Information

  1. Name:
  2. Box Number:
  3. Phone Number:
  4. Fax Number:
  5. Contact Person/Advisor's Name:
  6. Contact Person/Advisor's Phone:
  7. Contact Person/Advisor's Email:

Arrival/Departure Information

  1. Expected Arrival Date: (MM/DD/YYYY)
  2. Expected Departure Date: (MM/DD/YYYY)
  3. Names of family members arriving on this date and their ages:
  4. Will the department be arranging pickup for the scholar:
    International House does not provide airport pickups

Other Information

  1. Will the scholar be eligible for Duke Employee Health Insurance:
  2. If you need to provide us with additional information or have any comments, please include them here:
Please note that International House does not arrange housing prior to your arrival. We will send you useful information via email to help you start your housing search. To ensure the most comprehensive service, we would appreciate at least three weeks of notice before the scholar arrives.

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