Faculty Global Health Activity Form

Please complete a separate form for each global health activity. Direct any questions or concerns about the form to Tifany Frazer.

New activity
Activity update

Name

Title
MD
PhD

Email

Department

Collaboration Theme

Activity Synopsis

Country

Health Domain

(Check all that apply.)

Clinical Care
Community Health Center
Hospital
International NGO

Community and Public Health
Health Education Promotion
Injury Prevention and Control
Preventive Health Programs

Consultancy
General Practice
Healthcare Policy
Healthcare Systems Development
Research Development
Telemedicine

Education/Training
Allied Health Professionals
Community Health Workers
Community Members
Medical Students/Residents
Midwives
Nurses
Physicians
Post-doctorates
Postgraduate Students
Public Health Workers
Training the Trainers

Healthcare Systems Development
Electronic Medical Record
Systems Management Infrastructure Improvement

Research
Basic Science
Behavioral
Clinical
Public Health
Translational

Health Category

(Check all that apply.)
Child Health
Chronic Disease
Diagnostic Pathology
Disaster Relief
Elderly
Environmental Health
Family Health
Family Planning
ID (HIV/AIDS)
ID (Malaria)
ID (Parasitology)
ID (STI)
ID (TB)
Infectious Disease
Injury
Maternal/Child Health
Nutrition
Primary Care
Surgery
Systems Development

Notes

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