ORNL NSSD Collaborative Research Visitor’s Program 
Application Form
Due December 31, 2010

Visiting Researcher Personal Details:
A. Name _________________________________ Phone:________________ Email:_________________
B. Home Institution___________________________________________________
C. Status (check one):
* Regular faculty or research staff_______ (skip item D)
* Postdoctoral Fellow_______
* Graduate Student_________
D. Faculty mentor:____________________ Phone: _______________ Email: ______________________
E. For visitors who are not citizens of the United States please supply the following:
Current Citizenship________________
Country of birth (if different from above)______________
F. University Business Office Contact Information: Phone:________________ Email:_________________
	OR Sponsored Research Office: Phone:________________ Email: _________________________

 ORNL Scientific Collaborator:
A. Primary Collaborator_____________________________________
B. ORNL Host (if different from A)_____________________________

Proposed research topic:
__________________________________________________________________


Requested Starting Date and Duration:
__________________________________________________________________


Total Requested Budget:
__________________________________________________________________


Please attach the following (see instructions):
1. A research proposal (2 page maximum including figures and references)
2. Statement of work (1 page maximum), and a  deliverable (1 paragraph maximum) for contractual purposes
3. Statement of benefit to ORNL ( 1 page maximum,  provided by ORNL collaborator)
4. A detailed budget with justification
5. Curriculum Vitae of the visiting researcher, and for postdoctoral fellows or graduate students the CV of their mentor at the home institution.
6. A list of planned ORNL collaborators (if more than one) and a short CV of the primary ORNL collaborator.

This application, including research proposal, statement of work, and other materials should be prepared jointly with the primary ORNL collaborator.
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To submit the proposal, please e-mail the form and additional information to nsvisit@ornl.gov  as electronic attachments.  Acceptable file formats include:  PDF or MS-Word.