First Name *

Last Name *

Email *

Program Name *

Program Location *

Program Dates *

What is the name of your Academic Department and College? *

What is the estimated number of participants? *

Please enter the name of the host organization/partner/individual who is supporting your program. *

Which services are provided by the host organization/partner/individual in the host country? *
Arranges housing
Coordinates ground transportation
Airport greeting
Academic/classroom space
Coordination of group activities/site visits/excursions
Arrange for group meals
Host teaches a class
Arranges guest lectures
24/7 emergency response
In-country support team

What is the main reason for requesting a single program leader? *

If you are unable to continue your duties as the program director (due to illness, quarantine, isolation, family emergency, or some other reason), detail who would be available to lead the program. *

Detail what training and preparation is in place for that person to assume the responsibilities of the program in your absence (academically, logistically, and attending to the health and safety needs of students). *