International Visitors Application | Global Friendship Initiative

Name*

First Name (Given Name) Last Name (Family Name)

Email*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home Country*

Gender*

Male
Female

Birthday*

Purpose for your stay at NEOMED:*

In which college will you be working or studying?*

College of Graduate Studies
College of Medicine
College of Pharmacy

Please provide any information that would be helpful to the matching process.

Why do you want to participate in the Global Friendship Initiative?*

Liability Release*

I acknowledge that the Global Friendship Initiative is a service of Northeast Ohio Medical University intended only to increase intercultural understanding and introduce members of the community for intercultural interaction for education purposes. I further acknowledge that my participation in this initiative is entirely voluntary and that Northeast Ohio Medical University assumes no responsibility related to my participation or the outcome of my interactions with other participants in this initiative.

I understand.

By printing your name below you are signing this application.*

Today's Date*

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Office of Global Engagement

Global Friendship Initiative Application

For International Visitors

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