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Global Health Scholars Program (GHSP) Interest Indicator
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* Indicates required question
Are you a physician/professional or medical student?
Physician/Professional
Medical Student
Other
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Full Name, Degree/Year: (ex. Jane Doe, MD or John Doe, M4)
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Your answer
Affiliations: (ex. MU)
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Your answer
Specialty: (ex. Family Medicine or N/A for students)
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Your answer
Titles/Roles: (ex. Associate Professor or N/A)
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Your answer
Locations of Global Health Experiences/Interests:
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Your answer
Types of Global Health Experiences/Interests (please check all that apply):
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Humanitarian Trips
Research
Practice/Training in other countries
Peace Corp/Public Service Program
Military Service
Other:
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Description of Global Health Experiences/Interests:
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Your answer
Interests in GHSP Involvement (please check all that apply):
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Speaking at a GHSP educational event about your experiences
Engaging GHSP students in your current global health work
Meeting/Corresponding with GHSP students interested in your experiences
Mentoring a GHSP student
Other
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Other comments, questions, or concerns:
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