Global Health Elective PRE-Approval Form » Global Health Education Program » College of Medicine

PREREQUISITE: Must complete pre-departure training.
NOTE: This request must be completed with signature of sponsor and submitted at least 12 weeks PRIOR to course start date.
Name
First Last
Phone
Course Sponsor
First Last
Location / Contact Information
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Phone
Fax
Start Date:
DD dash MM dash YYYY
End Date:
DD dash MM dash YYYY
Proportion of student's time and hours of credit: (i.e. 4 weeks of 100% = 4 credits)
Description of Rotation: (please attach additional information as necessary)
File
Max. file size: 125 MB.
Learning objectives:
Summary of Evaluation Process:
In-Country host's email stating rotation approved
Max. file size: 125 MB.
I attest I have purchased CISI through UFIC on the date listed below (https://internationalcenter.ufl.edu/node/116)
I attest I have completed the mandatory Travel Registration with UFIC on the date below (https://internationalcenter.ufl.edu/node/116)
By adding the date below, I attest I have completed the PRE-DEPARTURE TRAINING (https://www.edx.org/course/practitioners-guide-global-health-bux-globalhealthx#)
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

PREREQUISITE: Must complete pre-departure training.