Visiting Scholar Plan Brochure and Forms - northwestern 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Visitor Information section. Enter your Last Name, First Name, Date of Birth, Gender, Citizenship, and Visa Type. Ensure all fields are completed as they are mandatory.
3. In the Appointment Information section, provide your Title, Department, Appointment Start Date, and Appointment End Date. If there are any delays due to visa issues, make sure to notify Risk Management promptly.
4. Indicate whether you will be bringing dependents by selecting 'Yes' or 'No'. If yes, remember to complete and attach a Dependent Form.
5. Fill in the Plan Coverage Request section with the VSP Coverage Start and End Dates. Be aware of the health benefits eligibility based on your appointment date.
6. Complete the Department Contact information with their Name, Phone number, Email address, and Date. Finally, ensure that a Dean or Director signs the form before submission.
7. Submit the completed application to Pam Tackett at the Office of Risk Management for review via email.

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