Global Health Education Inquiry

Please complete the education inquiry form below as step one of the application process to apply for a global health education experience through the Robert J. Havey MD Institute for Global Health. This form should only be used by CURRENT NORTHWESTERN STUDENTS.

Name Name First Last
Northwestern Email
NU ID
Must be 7 characters. Currently Entered: 0 characters.
This inquiry form is intended only for current Northwestern students. Please enter your NU ID, which can be found on your WildCard.
Primary Phone Number Primary Phone Number - ### - ### ####
Year of Study or Program
Have you attended a Global Health Experience Information Session this academic year? (for medical students only)

Have you attended a Global Health Experience Information Session this academic year? (for medical students only) Yes No N/A
What language(s) do you speak and at what proficiency level?
Program(s) you are interested in:

Program(s) you are interested in: Centro de Investigaciones Tecnológicas Biomédicas y Medioambientales (CITBM) - Peru Centro Medico Susan Hou – Bolivia Charité Universitatsmedizin Berlin – Berlin, German Child Family Health International - Various Locations Clinica de Familia - La Romana, Dominican Republic Hillside Health Care Clinic – Eldridgeville, Belize Karolinska Institutet – Stockholm, Sweden Keio University - Tokyo, Japan Makerere University – Kampala, Uganda Peking University - Beijing China Royal College of Surgeons - Waterford, Ireland Stellenbosch University – Cape Town, South Africa Tel Aviv University – Israel Trinity College Dublin – Ireland Universidad Panamericana – Mexico City, Mexico Université Cheikh Anta Diop de Dakar – Dakar, Senegal Université de Strasbourg – Strasbourg, France University of Global Health Equity - Butaro District, Rwanda Unaffiliated Feinberg institution / Off-site rotation
Additional Comments: