Global Trainee Pre Visit Form

Please enter the answers to the best of your knowledge and abilities:

Name:

Email address:

Name of Primary UB Mentor:

Name of Primary Country Mentor:

Weekly Plan

Please give a brief overview of what you intend to do for each week along with your activities pertaining to your stay.

Extra items to consider:

US Embassy Appointment Date:

Planned Date of Arrival in Buffalo

Planned Date of Departure from Buffalo

Project Outline - Please attach document and submit with form

Upload IRB/Ethical Approval for Research

Visit Plan - Please attach document and submit with form

Laboratory rotation UZ Pharmacology lab

Lab supplies - To order/ prepare before arrival (budget document)

Health Insurance

Please make sure that Health Insurance is in place before landing to avoid unnecessary physical evaluation

Security Check

(Required)

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