Exit this survey

* 1. Name

* 2. Funding Source:

* 3. Name of the faculty or department supervisor for this grant?

* 4. City and Country in which you will conduct research:

* 5. During what term will you be conducting reserch?

* 6. What immunizations does the Centers for Disease Control recommend for you city/country?

* 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.)

* 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)

* 9. What is the name of your health insurance provider?

* 10. Does your health insurance provider offer services for travelers abroad?

* 11. If yes, how do you access the travel benefits while abroad?

* 12. What is the address and telephone number of the nearest US Embassy American Citizens Services?

* 13. Name the returned student(s) from your country to whom you spoke to prepare for your time abroad.

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