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Fulbright WHA Regional Travel Program
Visit Report Form
The Regional Travel Program Visit Report Form should be submitted within 30 days of the conclusion of the visit. Please take the time to consider your responses carefully. After submitting this form, you will receive an e-mail requesting your bank account information. Reimbursement may take up to four weeks after this form has been received.
Email
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Title
Name
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First
Last
Fulbright Host Institution:
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RTP Host Country and Host Institution:
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Field of Study:
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RTP Project initiated by:
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Please select
You
RTP host institution
US Embassy in RTP host country
Fulbright Commission in RTP host country
Please indicate who initiated the contact process for this RTP
Expected date of return to the U.S.:
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MM
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DD
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YYYY
Summary of Regional Travel Program activities (in less than 500 words):
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Please describe and list the places and institutions visited, purpose of each visit or activities conducted, and research and partnerships goals achieved during the visit.
What were the main outcomes of your visit in terms of research collaboration?
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Building linkages and collaboration in the region
Sharing your expertise
Joint presentations at conferences, annual meetings, etc.
Exploring areas of collaboration among your home university, Fulbright host institution, and RTP host institution
Possibility of research exchanges between your Fulbright host institution and RTP host institution
Publication of collaborative research (publications, books, manuscripts, etc.)
Exploring reaserch collaboration was not a goal of the RTP
Please select all the options that may apply
Please list any additional outcomes (in less than 300 words):
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What were the main outcomes of your visit in terms of institutional partnership building?
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Interest in continued collaboration / stronger partnership
Possibility of staff and student exchange (including fellowships and scholarships) between RTP host institution and home institution in the U.S.
Discussion / Development of new courses or programs at respective universities
Collaboration on curriculum development and academic program revision
Signing of a MOU between the Fulbright host institution and the RTP host institution
institutional partnership building was not a goal of the RTP
Please select all the options that may apply
Please list any additional outcomes (in less than 300 words):
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Please describe how your visit built institutional partnerships and linkages between your Fulbright host institution and the RTP host institution.
Please describe any circumstances that positively or negatively impacted the outcomes of your visit (in less than 200 words):
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Public Release (in less than 300 words):
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Please provide a summary of your experience suitable for public release. Include a lay summary of the activities and main outcomes, of the names of the institution(s) with whom you collaborated, and comment on why you pursued this opportunity. Please also include at least one photo.
Photo Upload
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Photo Upload
Photo Upload
Cost of air ticket:
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$
Dollars
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Cents
Proof of the airfare ticket purchase
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Additional costs (not to be reimbursed)
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$
Dollars
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Cents
Please enter the amount of any costs associated with this trip that you covered
Description of additional costs
If there were additional costs covered by you, please, list what these costs were (lodging, meals, local transportation, etc.)
Amount of RTP host institution cost share
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$
Dollars
.
Cents
Description of RTP host institution cost share
Please include the total amount of costs, if any, that were covered by the RTP host institution, such as meals, lodging, local transportation, or any other support provided by the RTP host institution
