Independent Research Abroad

 
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1. Name
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2. Funding Source:
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3. Name of the faculty or department supervisor for this grant?
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4. City and Country in which you will conduct research:
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5. During what term will you be conducting reserch?
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6. What immunizations does the Centers for Disease Control recommend for you city/country?
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7. What is the address and phone number of the nearest hospital/medical center? (If you will be in more than one location, list the nearest hospitals for each location.)
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8. What is the address and telephone number of the nearest US embassy or consulate? (If you are not a US citizen, give this information for your country's embassy)
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9. What is the name of your health insurance provider?
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10. Does your health insurance provider offer services for travelers abroad?
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11. If yes, how do you access the travel benefits while abroad?
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12. What is the address and telephone number of the nearest US Embassy American Citizens Services?
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13. Name the returned student(s) from your country to whom you spoke to prepare for your time abroad.
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