OU-HCOM -- International Programs

Below are the forms that must be competed in order to participate in an international program. Please feel free to contact the Office of Global Health if you have any questions. We can be reached at (740)593-2359 or by email at globalhealth@oucom.ohiou.edu.

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