Please note: This is a competitive application; not all requests will be accommodated. Scholarship will be given in the form of partial funding ($200-$1,500) as reimbursement after the international experience.

Please send your applicant statement and this application typed as one document (RTF, PDF, or Word file) and label each page with your name, location and date. 

APPLICANT’S NAME (LAST, FIRST):	
ADDRESS:	PHONE:	EMAIL:	
TRAVEL INFORMATION:
Title of Trip: Location: Dates:
Summary of Activities:	
BRIEFLY LIST FUNDING RECEIVED for this trip, if any:	
You may apply for funding ONLY if the international experience has been approved by the Office of Global Health

Approved:	Date:

Not Approved:	If not yet approved, please indicate where you are in the approval process:	
TRAVEL BUDGET:

		

		

		

ITEM (Per Person)	$ AMOUNT
Travel costs Lodging costs
Registration or visa costs Meal costs
Other costs (explain	) Total cost per person Other funding committed	

Please note that your scholarship will be furnished as reimbursement after travel expenses are incurred. Upon acceptance, please be sure to submit travel receipts at least equal to the amount of your award.

Please return this form and your applicant statement to the Office of Global Health, nv25@drexel.edu, 215.991.8535.

APPLICANT STATEMENT: 
In addition to the above form, please attach a statement (no more than 1 page) and address these points: 
1.	The academic, service, research and/or clinical focus of your trip. 
2.	The importance/relevance of the specific location/experience to your field/discipline. 
3.	Contributions to your learning/career.
4.	How, in the future, you will expand on what you will learn on this trip.

Upon your return, you are REQUIRED to do the following:

1.	Write a narration of your experience, including pictures. You will need written permission from patients.  We will post these: 
•	On the Global Health website, www.drexel.edu/medicine/Community-Engagement/Educational-Programs/Global-Health-Education/Student-Experiences/ for students to learn about your experience.  
•	Other Drexel sites (possibly), i.e., the Office of Global Engagement & Education Abroad or social media

2.	Meet with Dr. Varjavand for debriefing. 

3.	Complete an online feedback survey.

4.	Conduct and submit a scholarly endeavor based on this Global Health experience to at least one of the following local opportunities for presentation (for MS1 only, not for MS4 due to timing):  
•	Discovery Day (Fall): www.drexel.edu/medicine/Academics/Graduate-School/Events/Discovery-Day/ 
•	International Research Showcase (in May): www.drexel.edu/global/  
•	Student Conference on Global Challenges (Spring): www.drexel.edu/global/ 

5.	Consider submission for a publication. 

Please note that if you are collecting data, you will need to obtain IRB approval prior to your trip.

By submitting this application, you agree to abide by the policies covering this type of prize and all Drexel University regulations regarding the expenditure of funds.

Applicant Signature:  	

Date:  	

Please return this form and your applicant statement to the Office of Global Health, nv25@drexel.edu, 215.991.8535.
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