Researcher Name*DateAddressAddress 2CityZIP/Postal CodeState/Province/RegionCountryEmail address*PhoneInstitution/Affiliation Position/OccupationPurpose of Visit (e.g., Dissertation, Research for Publication, Documentary, etc.) Research Topic/Project NameIntent to PublishYesNoAuthor/Director/ProducerTitle of Work/PublicationPublisher/DistributorType of Publication (article, book, film, etc.)Expected Publication DateDistribution (number of copies, market, etc.)Timeline for ProjectImmediate Goal (what is it you hope to accomplish in this visit?)Date(s) and Preferred Times for Research Appointment (we will do our best to accommodate)I agree to abide by the guidelines of the Mount Carmel Archives for researchers*YesSignature*Please type the characters*This helps us prevent spam, thank you.DateSendThis field should be left blank