NAI-MIRS Sabbatical Application and Instructions

Intent to Apply

Please complete the following information to inform us of your interest in applying for a summer sabbatical. Once this information is submitted, a representative will contact you by phone to discuss your interest and what will be required of you to complete the application process.

Applicant and Institution Information

Title Dr. Mr. Mrs. Ms.
First Name
Last Name
Name of College/University
Type of Institution

Hispanic-Serving Institution
Historically Black College/University

 Tribal College
Other
Department
Position
  Full-time Part-time
Length of time with Institution (please indicate months/years/semesters/etc.)
Mailing Address 1
Mailing Address 2
City State ZIP+4 -
Phone 1 (preferred) ( ) - x
Phone 2 (optional) ( ) - x
Cell Phone ( ) -
Fax ( ) - x
Email 1 (preferred)
Email 2 (optional)

This opportunity is open to United States citizens or permanent residents only.

I affirm that I am a United States citizen: Yes No
I affirm that I am a permanent resident: Yes No

Preferred Sabbatical Research Institution and Mentor

Host Site
Host Investigator
Why are these
your preferred
site and investigator?

Abstract of Research Proposal

Summarize your research proposal in 300 words or less.

We are having spamming problems with our online applications. Please enter your college or university name exactly as you entered it above (it is recommended that you copy what you typed above and paste it here):

Although you will view a confirmation page on the next screen, your application has not been recorded unless you receive an email from us. Depending on your email server, you should receive a confirmation email within a couple of minutes of pressing the Submit button below. If you do not receive an email, check your spam or bulk email folder with a subject similar to "NAI-MIRS Intent to Apply." If you do not receive an email, you should re-submit your application, ensuring you type your information accurately.