Application for Visiting Scientist to a Center/Program

 
Please complete the following form and click on "Submit" at the bottom of this form.

Please Note: Completion of this form is required of all members of the Marine Biological Laboratory visiting research community except for faculty and students in summer courses. This includes Research Award Applicants and all visitors to resident laboratories.
 
Personal Data
 
Family (Last) Name: 
First Name:      Middle Name: 
Gender:  Male   Female
Highest Degree:  MD/PhD    MD    PhD    MS    BS    High School
 
Arrival Date:  (mm/dd/yyyy)
Departure Date:  (mm/dd/yyyy)  Be as accurate as possible
 
Academic Rank
(or equivalent): 
Professor   Associate Professor   Assistant Professor  
Post-Doc   Graduate Student   Undergraduate Student  
Other  
Citizenship:   (If not U.S. citizen)
 
Home Address and Phone
Street 1:      Street 2: 
City:      State/Province: 
Zip/Postal Code:      Country 
Email: 
Phone:      Fax: 
Cell Phone: 
 
Institution Address and Phone
Institution Name: 
Department: 
Street 1:      Street 2: 
City:      State/Province: 
Zip/Postal Code:      Country 
Email: 
Phone:      Fax: 
 
Best:  Mail: Home Inst.     Email: Home Inst.     Phone: Home Inst.
 
Emergency Contact
Contact Name: 
Contact Phone: 
 
Visitor Agreement for Non-Resident Scientists and Students
 
We are delighted that you have chosen to engage in research and educational programs at The Marine Biological Laboratory (MBL). During your stay here, you are part of the MBL and the broader Woods Hole community. As part of these communities, you will be expected to behave as a responsible member of the communities.
 
  1. During your visit, you will comply with all applicable laws, rules, and regulations and will follow the directions and guidance of MBL personnel. Even though you are not an employee of MBL, you will comply with all MBL rules, policies, and procedures that are applicable to its staff including those relating to alcohol, illegal drugs, and harassment. If you reside in MBL housing, you must comply with all MBL housing policies. You must review MBLŐs policies and procedures at: http://www.mbl.edu/hr/staff-toolbox/marine-biological-laboratory-policy-manual/.

  2. MBL greatly values its relationship with its surrounding community. During your visit, you will respect the property and rights of others. You will be responsible for any damage you cause to property of MBL or others.

  3. If you fail to comply with any of these obligations, MBL may immediately terminate your visit and your access to MBL facilities, equipment, and premises. Upon any such termination, you will leave and remove all of your personal property immediately when asked to do so and will immediately return all MBL property, including but not limited to any identification cards, keys, laboratory clothing, books, equipment, and documents.

  4. You must have your own health and/or accident insurance coverage that will cover any personal injury that you may sustain while at MBL, regardless of cause, and must provide proof of such insurance upon request.
I have read this Agreement and agree to its obligations including any fees associated with my stay at the MBL. I also agree to acknowledge the Marine Biological Laboratory in Woods Hole, MA, in all papers that I publish where a substantial portion of the work was undertaken at the MBL.

 I accept
 
Research Project Title (if applicable): 
 
Which Center/Program will you be visiting? 
 
MBL Hosts: 


 
 
 
 

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 Woods Hole Massachusetts