{"id":1947,"date":"2013-09-19T16:19:39","date_gmt":"2013-09-19T20:19:39","guid":{"rendered":"https:\/\/www.bumc.bu.edu\/ghbusm\/?page_id=1947"},"modified":"2025-06-20T15:11:11","modified_gmt":"2025-06-20T19:11:11","slug":"travel-grant","status":"publish","type":"page","link":"https:\/\/www.bumc.bu.edu\/ghbusm\/travel-grant\/","title":{"rendered":"Travel Grant Application for Medical Students"},"content":{"rendered":"<p>Fourth-year medical students may use the following application to apply for\u00a0a travel grant for a GH elective. Applications are processed on a rolling basis with a funding determination sent to the student within 3 weeks of submission. If you do not receive a response within 3 weeks of submission, email<span>\u00a0<\/span><a href=\"mailto:anagreg@bu.edu\">Ana Gregory<\/a>.<\/p>\n<p><strong>Before completing the application below, view <a href=\"https:\/\/www.bumc.bu.edu\/ghbusm\/setupelective\/travelgrants\/\">Travel Grants for M4 Students<\/a><\/strong>\u00a0to understand the Global Health Program&#8217;s funding priorities.<\/p>\n<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_3' ><form method='post' enctype='multipart\/form-data'  id='gform_3'  action='\/ghbusm\/wp-json\/wp\/v2\/pages\/1947' data-formid='3' >\n                        <div class='gform-body gform_body'><ul id='gform_fields_3' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_3_5\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_5\"><label class='gfield_label gform-field-label' for='input_3_5' >Today&#039;s Date:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_5' id='input_3_5' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_3_5_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_3_5_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_3_5' class='gform_hidden' value='https:\/\/www.bumc.bu.edu\/ghbusm\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_3_81\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_81\"><h2 class=\"gsection_title\">Section I: Student Information<\/h2><\/li><li id=\"field_3_1\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_1\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >1. Student Name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_3_1'>\n                            <span id='input_3_1_3_container' class='name_first gform-grid-col' >\n                                                    <input type='text' name='input_1.3' id='input_3_1_3' value=''   aria-required='true'    \/>\n                                                    <label for='input_3_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                               <\/span>\n                            <span id='input_3_1_6_container' class='name_last gform-grid-col' >\n                                                    <input type='text' name='input_1.6' id='input_3_1_6' value=''   aria-required='true'    \/>\n                                                    <label for='input_3_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            <div class='gf_clear gf_clear_complex'><\/div>\n                        <\/div><\/li><li id=\"field_3_76\"  class=\"gfield gfield--type-number gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_76\"><label class='gfield_label gform-field-label' for='input_3_76' >2. Class year of student:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_76' id='input_3_76' type='text'    value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_3_76\" \/><div class='gfield_description instruction ' id='gfield_instruction_3_76'>Please enter a number from <strong>2020<\/strong> to <strong>2030<\/strong>.<\/div><\/div><\/li><li id=\"field_3_30\"  class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_30\"><label class='gfield_label gform-field-label' for='input_3_30' >3. Student Phone:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_30' id='input_3_30' type='text' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_3_31\"  class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_31\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >4. Student E-mail<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_3_31_container'>\n                                <span id='input_3_31_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='text' name='input_31' id='input_3_31' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_3_31' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_3_31_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='text' name='input_31_2' id='input_3_31_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_3_31_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><li id=\"field_3_80\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_80\"><h2 class=\"gsection_title\">Section II: Host Information<\/h2><\/li><li id=\"field_3_32\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_32\"><label class='gfield_label gform-field-label' for='input_3_32' >5. Primary Host Organization Name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_3_32' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_3_35\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_35\"><label class='gfield_label gform-field-label' for='input_3_35' >6. Host Contact Name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_3_35' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_3_37\"  class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_37\"><label class='gfield_label gform-field-label' for='input_3_37' >7. Host Contact E-mail Address:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_37' id='input_3_37' type='text' value='' class='small'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_3_38\"  class=\"gfield gfield--type-website field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_38\"><label class='gfield_label gform-field-label' for='input_3_38' >8. Host Organization Website:<\/label><div class='ginput_container ginput_container_website'>\n                    <input name='input_38' id='input_3_38' type='text' value='' class='small'      aria-invalid=\"false\"\/>\n                <\/div><\/li><li id=\"field_3_36\"  class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_36\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >9. Host Address:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_3_36' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_3_36_1_container' >\n                                        <input type='text' name='input_36.1' id='input_3_36_1' value=''    aria-required='true'    \/>\n                                        <label for='input_3_36_1' id='input_3_36_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_3_36_2_container' >\n                                        <input type='text' name='input_36.2' id='input_3_36_2' value=''     aria-required='false'   \/>\n                                        <label for='input_3_36_2' id='input_3_36_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_3_36_3_container' >\n                                    <input type='text' name='input_36.3' id='input_3_36_3' value=''    aria-required='true'    \/>\n                                    <label for='input_3_36_3' id='input_3_36_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_3_36_4_container' >\n                                        <input type='text' name='input_36.4' id='input_3_36_4' value=''      aria-required='true'    \/>\n                                        <label for='input_3_36_4' id='input_3_36_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_3_36_5_container' >\n                                    <input type='text' name='input_36.5' id='input_3_36_5' value=''    aria-required='true'    \/>\n                                    <label for='input_3_36_5' id='input_3_36_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_3_36_6_container' >\n                                        <select name='input_36.6' id='input_3_36_6'   aria-required='true'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_3_36_6' id='input_3_36_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_3_82\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_82\"><h2 class=\"gsection_title\">Section III: Details of Your Elective<\/h2><div class='gsection_description' id='gfield_description_3_82'>NOTE: The quality of the information that you provide below will assist the funding committee in determining the amount of funding you will receive. Provide as many details as possible in a well-written manner. <\/div><\/li><li id=\"field_3_46\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_46\"><label class='gfield_label gform-field-label' for='input_3_46' >10. What is the main specialty of your GH elective (e.g., primary care, ob\/gyn, etc.)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_3_46' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_3_44\"  class=\"gfield gfield--type-date gfield--input-type- gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_44\"><label class='gfield_label gform-field-label' for='input_3_44' >11. Start Date of Elective:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_44' id='input_3_44' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'    aria-describedby=\"input_3_44_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_3_44_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_3_44' class='gform_hidden' value='https:\/\/www.bumc.bu.edu\/ghbusm\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_3_45\"  class=\"gfield gfield--type-date gfield--input-type- gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_45\"><label class='gfield_label gform-field-label' for='input_3_45' >12. End Date of Elective:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_45' id='input_3_45' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'    aria-describedby=\"input_3_45_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_3_45_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_3_45' class='gform_hidden' value='https:\/\/www.bumc.bu.edu\/ghbusm\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_3_47\"  class=\"gfield gfield--type-number gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_47\"><label class='gfield_label gform-field-label' for='input_3_47' >13. Total number of weeks abroad for your elective:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_47' id='input_3_47' type='text'    value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_40\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_40\"><label class='gfield_label gform-field-label' for='input_3_40' >14. Destination Country:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_3_40' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_3_41\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_41\"><label class='gfield_label gform-field-label' for='input_3_41' >15. Destination Cities and\/or Towns:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_41' id='input_3_41' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_3_42\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_42\"><label class='gfield_label gform-field-label'  >16. Is there a State Dept. travel warning issued for your destination country?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_42'>\n\t\t\t<li class='gchoice gchoice_3_42_0'>\n\t\t\t\t<input name='input_42' type='radio' value='No'  id='choice_3_42_0'    \/>\n\t\t\t\t<label for='choice_3_42_0' id='label_3_42_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_42_1'>\n\t\t\t\t<input name='input_42' type='radio' value='Yes'  id='choice_3_42_1'    \/>\n\t\t\t\t<label for='choice_3_42_1' id='label_3_42_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_43\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_43\"><b>NOTE: <\/b>BUSM GH Program will not give academic credit for, pay \n  for, supervise, direct, or otherwise support a medical student in a country \n  where a <a href=\"http:\/\/travel.state.gov\" target=\"_blank\">U.S. State Department \n  Travel Warning<\/a> is in effect. See <a href=\"http:\/\/www.bumc.bu.edu\/ghbusm\/files\/Travel_Warning_Policy.pdf\" target=\"_blank\">Travel \n  Warning Policy<\/a>.<\/li><li id=\"field_3_48\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_48\"><label class='gfield_label gform-field-label'  >17. Is there a language requirement for the elective (besides English)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_48'>\n\t\t\t<li class='gchoice gchoice_3_48_0'>\n\t\t\t\t<input name='input_48' type='radio' value='No'  id='choice_3_48_0'    \/>\n\t\t\t\t<label for='choice_3_48_0' id='label_3_48_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_48_1'>\n\t\t\t\t<input name='input_48' type='radio' value='Yes'  id='choice_3_48_1'    \/>\n\t\t\t\t<label for='choice_3_48_1' id='label_3_48_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_49\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_49\"><label class='gfield_label gform-field-label' for='input_3_49' >18. If you answered &#039;Yes&#039; for question 17, what languages are required and what is your skill level for these languages?<\/label><div class='ginput_container ginput_container_text'><input name='input_49' id='input_3_49' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_3_91\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_91\"><h2 class=\"gsection_title\">Section IV: Trip Costs<\/h2><\/li><li id=\"field_3_51\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_51\"><b>19. What are your estimated trip costs?\n<\/b> <p>Enter an estimated dollar amount for each trip expense listed below; the form will total the expenses for you. The costs should be based on your research or input from elective site. Do not make a guess as the info you provide is used to determine the final amount of your award. <\/p><\/li><li id=\"field_3_50\"  class=\"gfield gfield--type-product gfield--input-type-price gfield_price gfield_price_3_50 gfield_product_3_50 field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_50\"><label class='gfield_label gform-field-label' for='input_3_50' >&gt;  Airfare<\/label><div class='ginput_container ginput_container_product_price'>\n\t\t\t\t\t<input name='input_50' id='input_3_50' type='text' value='' class='medium ginput_amount'    aria-invalid=\"false\"  \/>\n\t\t\t\t<\/div><\/li><li id=\"field_3_52\"  class=\"gfield gfield--type-product gfield--input-type-price gfield_price gfield_price_3_52 gfield_product_3_52 field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_52\"><label class='gfield_label gform-field-label' for='input_3_52' >&gt;  Local Travel (bus, taxi, etc.)<\/label><div class='ginput_container ginput_container_product_price'>\n\t\t\t\t\t<input name='input_52' id='input_3_52' type='text' value='' class='medium ginput_amount'    aria-invalid=\"false\"  \/>\n\t\t\t\t<\/div><\/li><li id=\"field_3_54\"  class=\"gfield gfield--type-product gfield--input-type-price gfield_price gfield_price_3_54 gfield_product_3_54 field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_54\"><label class='gfield_label gform-field-label' for='input_3_54' >&gt; Housing<\/label><div class='ginput_container ginput_container_product_price'>\n\t\t\t\t\t<input name='input_54' id='input_3_54' type='text' value='' class='medium ginput_amount'    aria-invalid=\"false\"  \/>\n\t\t\t\t<\/div><\/li><li id=\"field_3_55\"  class=\"gfield gfield--type-product gfield--input-type-price gfield_price gfield_price_3_55 gfield_product_3_55 field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_55\"><label class='gfield_label gform-field-label' for='input_3_55' >&gt;  Food<\/label><div class='ginput_container ginput_container_product_price'>\n\t\t\t\t\t<input name='input_55' id='input_3_55' type='text' value='' class='medium ginput_amount'    aria-invalid=\"false\"  \/>\n\t\t\t\t<\/div><\/li><li id=\"field_3_56\"  class=\"gfield gfield--type-product gfield--input-type-price gfield_price gfield_price_3_56 gfield_product_3_56 field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_56\"><label class='gfield_label gform-field-label' for='input_3_56' >&gt;  Program Fee<\/label><div class='ginput_container ginput_container_product_price'>\n\t\t\t\t\t<input name='input_56' id='input_3_56' type='text' value='' class='medium ginput_amount'    aria-invalid=\"false\"  \/>\n\t\t\t\t<\/div><\/li><li id=\"field_3_57\"  class=\"gfield gfield--type-product gfield--input-type-price gfield_price gfield_price_3_57 gfield_product_3_57 field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_57\"><label class='gfield_label gform-field-label' for='input_3_57' >&gt;  Immunizations<\/label><div class='ginput_container ginput_container_product_price'>\n\t\t\t\t\t<input name='input_57' id='input_3_57' type='text' value='' class='medium ginput_amount'    aria-invalid=\"false\"  \/>\n\t\t\t\t<\/div><\/li><li id=\"field_3_53\"  class=\"gfield gfield--type-total gfield_price gfield_price_3_ gfield_total gfield_total_3_ field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  aria-atomic=\"true\" aria-live=\"polite\" data-js-reload=\"field_3_53\"><label class='gfield_label gform-field-label' for='input_3_53' >&gt;&gt; Total Estimated Expenses<\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<span class='ginput_total ginput_total_3'>$0.00<\/span>\n\t\t\t\t\t\t\t<input type='hidden' name='input_53' id='input_3_53' class='gform_hidden'\/>\n\t\t\t\t\t\t<\/div><\/li><li id=\"field_3_61\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_61\"><label class='gfield_label gform-field-label' for='input_3_61' >20. For the expenses listed above, what is the source of your information (website, program contact, etc.)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_61' id='input_3_61' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_3_98\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_98\"><label class='gfield_label gform-field-label'  >21. What type of housing accommodations will you have during your elective?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_98'>\n\t\t\t<li class='gchoice gchoice_3_98_0'>\n\t\t\t\t<input name='input_98' type='radio' value='Airbnb'  id='choice_3_98_0'    \/>\n\t\t\t\t<label for='choice_3_98_0' id='label_3_98_0' class='gform-field-label gform-field-label--type-inline'>Airbnb<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_98_1'>\n\t\t\t\t<input name='input_98' type='radio' value='Hotel'  id='choice_3_98_1'    \/>\n\t\t\t\t<label for='choice_3_98_1' id='label_3_98_1' class='gform-field-label gform-field-label--type-inline'>Hotel<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_98_2'>\n\t\t\t\t<input name='input_98' type='radio' value='Housing provided by program'  id='choice_3_98_2'    \/>\n\t\t\t\t<label for='choice_3_98_2' id='label_3_98_2' class='gform-field-label gform-field-label--type-inline'>Housing provided by program<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_98_3'>\n\t\t\t\t<input name='input_98' type='radio' value='I am staying with family\/friends'  id='choice_3_98_3'    \/>\n\t\t\t\t<label for='choice_3_98_3' id='label_3_98_3' class='gform-field-label gform-field-label--type-inline'>I am staying with family\/friends<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_98_4'>\n\t\t\t\t<input name='input_98' type='radio' value='gf_other_choice'  id='choice_3_98_4'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_3_98_other' name='input_98_other' type='text' value='Other' aria-label='Other' onfocus='jQuery(this).prev(\"input\")[0].click(); if(jQuery(this).val() == \"Other\") { jQuery(this).val(\"\"); }' onblur='if(jQuery(this).val().replace(\" \", \"\") == \"\") { jQuery(this).val(\"Other\"); }'   \/>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_62\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_62\"><label class='gfield_label gform-field-label'  >22. Have you applied for funding from other sources to support your elective?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_62'>\n\t\t\t<li class='gchoice gchoice_3_62_0'>\n\t\t\t\t<input name='input_62' type='radio' value='No'  id='choice_3_62_0'    \/>\n\t\t\t\t<label for='choice_3_62_0' id='label_3_62_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_62_1'>\n\t\t\t\t<input name='input_62' type='radio' value='Yes'  id='choice_3_62_1'    \/>\n\t\t\t\t<label for='choice_3_62_1' id='label_3_62_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_63\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_63\"><label class='gfield_label gform-field-label' for='input_3_63' >23. If yes, what are these sources?<\/label><div class='ginput_container ginput_container_text'><input name='input_63' id='input_3_63' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_3_96\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_96\"><h2 class=\"gsection_title\">Section V: Describe the Different Aspects of Your Elective<\/h2><\/li><li id=\"field_3_66\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_66\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >24. What are the main components of your elective? (check all that apply)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_3_66'><li class='gchoice gchoice_3_66_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_66.1' type='checkbox'  value='23. clinical experience'  id='choice_3_66_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_66_1' id='label_3_66_1' class='gform-field-label gform-field-label--type-inline'>clinical experience<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_3_66_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_66.2' type='checkbox'  value='23. research'  id='choice_3_66_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_66_2' id='label_3_66_2' class='gform-field-label gform-field-label--type-inline'>research<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_3_66_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_66.3' type='checkbox'  value='23. language\/cultural study'  id='choice_3_66_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_66_3' id='label_3_66_3' class='gform-field-label gform-field-label--type-inline'>language\/cultural study<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_3_66_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_66.4' type='checkbox'  value='23. community\/public health project'  id='choice_3_66_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_66_4' id='label_3_66_4' class='gform-field-label gform-field-label--type-inline'>community\/public health project<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_65\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_65\"><label class='gfield_label gform-field-label' for='input_3_65' >25. Describe the clinical aspects of your elective including patient population, daily schedule, wards on which you will rotate, etc.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_65' id='input_3_65' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_3_67\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_67\"><label class='gfield_label gform-field-label' for='input_3_67' >26. Describe the research aspects of your elective (if none, indicate that).<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_67' id='input_3_67' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_3_68\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_68\"><label class='gfield_label gform-field-label' for='input_3_68' >27. Describe the language study aspects of your elective, e.g., the amount of instruction you will receive, etc. (if no language component, indicate that).<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_68' id='input_3_68' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_3_69\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_69\"><label class='gfield_label gform-field-label' for='input_3_69' >28. Describe the community\/public health aspects of your elective (if none, indicate that)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_69' id='input_3_69' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_3_83\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_83\"><h2 class=\"gsection_title\">Section VI: Personal Reflection\/How This Elective Fits into Your Career Plans<\/h2><\/li><li id=\"field_3_71\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_71\"><label class='gfield_label gform-field-label' for='input_3_71' >29. How do your past experiences demonstrate your ability to make this a successful experience?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_71' id='input_3_71' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_3_72\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_72\"><b>30. List the three main educational benefits that you expect to receive from your experience, including curriculum goals and\/or post-graduate career plans. \n<\/b> <\/li><li id=\"field_3_73\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_73\"><label class='gfield_label gform-field-label' for='input_3_73' >Benefit #1<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_73' id='input_3_73' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_3_74\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_74\"><label class='gfield_label gform-field-label' for='input_3_74' >Benefit #2<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_74' id='input_3_74' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_3_75\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_75\"><label class='gfield_label gform-field-label' for='input_3_75' >Benefit #3<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_75' id='input_3_75' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_3_86\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_86\"><h2 class=\"gsection_title\">Section VII: If Your Elective Program is Cancelled<\/h2><\/li><li id=\"field_3_87\"  class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_87\"><label class='gfield_label gform-field-label' for='input_3_87' >31. If your elective program is abruptly ended due to disaster-level conditions (civil unrest,  natural disaster) or Covid, what are your plans for accommodations and return flight to US?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_87' id='input_3_87' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_3_89\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_89\"><label class='gfield_label gform-field-label'  >32. Do you have housing in the U.S. if your elective program is cancelled?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_89'>\n\t\t\t<li class='gchoice gchoice_3_89_0'>\n\t\t\t\t<input name='input_89' type='radio' value='Yes'  id='choice_3_89_0'    \/>\n\t\t\t\t<label for='choice_3_89_0' id='label_3_89_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_89_1'>\n\t\t\t\t<input name='input_89' type='radio' value='No'  id='choice_3_89_1'    \/>\n\t\t\t\t<label for='choice_3_89_1' id='label_3_89_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_90\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_90\"><h2 class=\"gsection_title\">Section VIII: Understand Your Responsiblities &amp; Verify Your Submission<\/h2><\/li><li id=\"field_3_77\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_77\">All students who undertake a 4th-year GH elective must complete the required list of <a href=\"http:\/\/www.bumc.bu.edu\/ihbusm\/setupelective\/responsibilities\/\" target=\"_blank\">responsibilities.<\/a> Please review these responsibilities, then check the boxes below to submit your application.<\/p>\n<\/li><li id=\"field_3_92\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_92\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >I have read and understand the list of required responsibilities that I must complete before I undertake my elective (website listed above).<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_3_92'><li class='gchoice gchoice_3_92_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_92.1' type='checkbox'  value='Check here to confirm the above.'  id='choice_3_92_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_92_1' id='label_3_92_1' class='gform-field-label gform-field-label--type-inline'>Check here to confirm the above.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_95\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_95\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >By submitting this form for consideration, I certify that, to the best of my knowledge, the information contained in the from is true and correct.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_3_95'><li class='gchoice gchoice_3_95_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_95.1' type='checkbox'  value='I certify the above.'  id='choice_3_95_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_95_1' id='label_3_95_1' class='gform-field-label gform-field-label--type-inline'>I certify the above.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_78\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label gfield_visibility_hidden\"  data-js-reload=\"field_3_78\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex'  ><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_3_78'><li class='gchoice gchoice_3_78_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.1' type='checkbox'  value='I have read and understand the list of required responsibilities that I must complete before I undertake my elective (website listed above).'  id='choice_3_78_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_78_1' id='label_3_78_1' class='gform-field-label gform-field-label--type-inline'>I have read and understand the list of required responsibilities that I must complete before I undertake my elective (website listed above).<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_79\"  class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below hidden_label gfield_visibility_hidden\"  data-js-reload=\"field_3_79\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex'  ><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_3_79'><li class='gchoice gchoice_3_79_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.1' type='checkbox'  value='By submitting this form for consideration, I certify that, to the best of my knowledge, the information contained in the form is true and correct.'  id='choice_3_79_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_79_1' id='label_3_79_1' class='gform-field-label gform-field-label--type-inline'>By submitting this form for consideration, I certify that, to the best of my knowledge, the information contained in the form is true and correct.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_85\"  class=\"gfield gfield--type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_3_85\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_3_85' >30. Submit Covid Action Plan document here:<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='104857600' \/><input name='input_85' id='input_3_85' type='file' class='medium' aria-describedby=\"gfield_upload_rules_3_85\" onchange='javascript:gformValidateFileSize( this, 104857600 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_3_85'>Max. file size: 100 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_3_85'><\/div><\/div><\/li><li id=\"field_3_99\"  class=\"gfield gfield--type-section gsection bu_google_recaptcha_section field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_99\"><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_3_100\"  class=\"gfield gfield--type-html bu_google_recaptcha gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_100\"><div class=\"g-recaptcha\" data-sitekey=\"6LeGxkEjAAAAAK4nzHZn3a_6jB2ELSN935WrVBfC\"><\/div><\/li><\/ul><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_3' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_3\"]){return false;}  window[\"gf_submitting_3\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_3\"]){return false;} window[\"gf_submitting_3\"]=true;  jQuery(\"#gform_3\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_3' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='3' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_3' value='WyJ7XCI5OFwiOltcImM0NTBjMTdmNWEzN2ZjMTQyNzZkNjkyYzY3OGI4ZTBiXCIsXCI0NDMyMGJhNDc4MDA4NGJjZTNhODgxYTdlMjMwZGNlNlwiLFwiZGU3ZTgzNzcyOTQ3NDE2ZTM1MzViMjRlMWExY2M4NWZcIixcIjYwYjZjMjJhODA2YWY0NmYzMGNiY2Q0YzE2YzE4OTkzXCJdLFwiODlcIjpbXCJlMmIzMDRiMzNhOWIyZTJlZjExZjY5OTdiOTY0YmZjM1wiLFwiMDgyMTE2NDI3ODgwNzY3YTcxMDhhNjRhZDM4Zjc0ZjVcIl0sXCI5Mi4xXCI6XCI0NDc1MGIzMjcwYTBiZDY3OWZlYTAyMTU5NTc0NzdjZFwiLFwiOTUuMVwiOlwiMGE0YTMxOGJlNTliZTA4MmQyZDc2MTlmZGQ0YTVlN2JcIn0iLCI5M2UxMWVkY2Y3ZWU5YWIwMTMzOTNmZTY1MjZmMTNhNCJd' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_3' id='gform_target_page_number_3' value='0' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_3' id='gform_source_page_number_3' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div><script type=\"text\/javascript\">\ngform.initializeOnLoaded( function() {gformInitSpinner( 3, 'https:\/\/www.bumc.bu.edu\/ghbusm\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_3').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_3');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_3').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! 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Applications are processed on a rolling basis with a funding determination sent to the student within 3 weeks of submission. If you do not receive a response within 3 weeks of submission, email\u00a0Ana Gregory. 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