Project Submission Form

Welcome to the Office of International Medicine Programs (IMP), International Activities Database. This database will serve as a comprehensive repository of information about all of the international projects and activities taking place at the GW School of Medicine and Health Sciences (SMHS). This database is regularly used by GW leadership to stay up-to-date on international projects occurring across the globe. Such information provides a benefit to you as well in terms of the existence of an accurate and current database from which to draw when visiting various countries. In addition, the database provides a venue for showcasing the important work you are engaged in globally.

Please provide the following information on all of your international activities and projects across the globe to include any lectures or presentations given, collaborative research, missions, etc. Any questions regarding this effort may be directed to (impinfo@gwu.edu). Thank you in advance for your help.

* indicates a required field.

Faculty Information

* First Name
* Last Name
* Title
* Department
Collaborating Departments (if applicable)
* Phone
* Email Address

International Project/Activity (current/ongoing or in development)

Please complete a separate entry for every project/activity you are participating in abroad whether it is current/ongoing or in development. Projects or activities can include: lectures or presentations given; collaborative research; missions; site visits; etc.

* Project Title
* Scope/Description
If the international activity you are entering spans across multiple regions, please select "Global" as the region of your activity. If your international project spans multiple countries within the same region, please select the region, and then indicate in the spaces provided the countries and if applicable, cities involved in your international activity.
* Region
* Country One
* City One
Country Two
City Two
Country Three
City Three

Affiliated/Partnering Institution

* Are you working with an affiliated/partnering institution on this project/activity?
* Affiliated/Partnering Institution
First Name
Last Name
Title
Phone
Email Address
Website
Additional Notes

Additional Information

* Is this project funded, IRB research, or have a legal agreement?
Project/Contract/Proposal Number
IRB Number
Project Sponsor
Type of Agreement
Effective Date of Agreement
Expiration Date of Agreement

Project Achievements

* Do students, residents, fellows, other GW faculty and staff, or international scholars participate in this project/activity?
Number of GW students participated
Number of GW residents and fellows
Number of international students participated
Number of GW faculty participated
Number of international faculty participated
Number of visiting scholars
Number of GW staff members participated
Number of employees working in country
Additional achievements
* Does the project/activity generate funds?
Money generated
Additional achievements
* Were joint research articles published?
Number of joint publications
Additional achievements
* Were courses or workshops offered?
Number of courses offered
Number of certificates given
Number of events and workshops
Additional achievements

Project Timeline

* Project Start Date
Project End Date
If the project does not have an end date is this an on-going project?

After review by the Office of International Medicine Programs (IMP), the following information will be included in the public version: Location of project, Affiliated Institutes, Title and Scope of Project, and Point of Contact at GW.