The following forms
can be downloaded to your computer in Adobe Acrobat
Reader, which is available
free. Please
contact
Office
of Global Health
if you are unable to download any of the
forms.
All Applicants:
We have moved to an on-line application process. See individual programs for due dates
http://eais.admsrv.ohio.edu/eais/student- application
for all participants in OU-HCOM Global Health Programs
including preceptors.
HTH Worldwide Health
Insurance Enrollment
Visa - links to the
U.S. Department of State and lists the requirements
for entry to the country you are traveling to. There
are also links to the appropriate embassy websites.
Embassy registration
- links to the U.S. Department of State website in
order for you to register. Please remember to print
or copy your information before you click submit and
send a copy the Office of Global Health Programs.
Confirmation of
Embassy Registration
OU Waiver Form -
for travel to country with US State Department
travel warning, Currently, this includes Kenya.
Evaluation
- Complete online evaluation after your return
Independent/IP
Int'l Med Health Clinical Site Eval.doc
- Independent Clinical Rotation
Evaluation to be completed upon your return.
Independent/IP Int'l Med Research Rotation Site
Eval.doc - Independent Research Rotation
evaluation to be completed upon your return.
Non-Degree Application
- required for all non-Ohio University
students, volunteers, advisors or employees. The application fee is waived if paperwork is sent
directly to the Office of Global Health Programs.
Nonmedical participants: Send
copy of transcripts or diploma.
Licensed health care providers: Provide
a photocopy of your
state medical certification/license.
Ihttp://www.ohiocore.org/gfx/media/contribute/ProfileandDisclosureFormJanuary1-13-09.pdf
- Faculty Profile Form
Supplemental Application for
International Rotation - application form required only for independent
rotations.
Malpractice Insurance
(New):
AMPIE Medical Student Application
Agreement
Preceptor Forms:
Faculty Profile Form
Preceptor Agreement Form
Please return all
forms to:
Ohio University Heritage College of
Osteopathic Medicine
Office of Global Health
231 Grosvenor Hall
Athens, OH 45701
Email: globalhealth@oucom.ohiou.edu
Phone: 740-593-2359
Fax: 740-593-2320
Please feel free to
contact the Office of Global Health if you have any
questions.
OU-HCOM Pre-departure Preparations
Checklist -
general checklist of required
documents to aid in your travel preparations
Travel tips - tips
on preparation, packing, flights, etc for any OU-HCOM
Global Health Program |