Full Name *
UR Email Address *
URID *
URochester School (Primary) –Please select– Arts and Sciences Eastman Institute for Oral Health Eastman School of Music Hajim School of Engineering and Applied Sciences School of Medicine and Dentistry School of Nursing Simon Business School Warner School of Education and Human Development Central Administration Unit Other
URochester Department or Unit (Primary)
Which type of global experience are you considering? Athletics and Recreation COIL or Virtual Global Programs Experiential Learning Faculty Mobility Field Service General Collaboration Global Course Creation Internship Joint Degree Program Masterclass Research Student Mobility Teach Abroad Other Select all that apply. On Windows, hold Ctrl; on Mac, hold Command.
Proposed Country Location(s) Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius, and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Curaçao Cyprus Czechia Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands North Macedonia Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U. S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands United States of America Uruguay Uzbekistan Vanuatu Venezuela Vietnam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Select all that apply. On Windows, hold Ctrl; on Mac, hold Command.
Do you currently have an identified partner institution or organization? –Please select– Yes No
If yes, please include the name of the institution or organization.
What stage is this initiative currently in? –Please select– Initial idea/exploration Active discussions with potential partner(s) Existing relationship or partner in place Previously offered program being renewed/expanded Other
When would the activities or partnership occur? Spring 2027 Summer 2027 Fall 2027 Spring 2028 Summer 2028 Fall 2028 Other Select all that apply. On Windows, hold Ctrl; on Mac, hold Command.
What is your level of familiarity with the proposed location(s) and/or partner organization(s)? –Please select– No prior familiarity or experience Limited familiarity (research, professional contacts, or brief visits) Previous experience (visited, worked, studied, or collaborated there) Established relationship(s) or ongoing collaboration(s) Extensive expertise and connections in the location and/or with the partner
Have you previously participated in an international partnership, research collaboration, or URochester global program? –Please select– Yes No
If yes, please provide details on this experience. Include dates, length of global service, location(s), and global experience objectives.
Who is your intended audience or participant? Undergraduate students Graduate students Medical Students Residents Faculty Other Select all that apply. On Windows, hold Ctrl; on Mac, hold Command.
What are your primary objectives for this initiative? Community engagement/service Curriculum development Faculty development Global reputation and visibility International partnership development Recruitment and enrollment Research collaboration Student learning and academic enrichment Other Select all that apply. On Windows, hold Ctrl; on Mac, hold Command.
In your own words, briefly describe your proposed activity and/or partnership. 500 words max.
Additional Details, Comments, or Questions Please include details for any field where you selected “Other,” along with any additional comments or questions.
