MUSC FACULTY SURVEY 1998
International Collaborative Activities
The International Committee is seeking your help. We are starting a database of international collaborative activities in order to facilitate new initiatives. Please be kind enough to complete this survey.
Click to move
cursor. Then enter data. Then click on submit data.
Name
Male
Female Dept
Telephone
Fax
E-Mail
Country of Birth
US Citizen
Permanent Resident
Non-Resident Alien
Foreign Languages Spoken
1. Do you have on-going or prior collaboration(s) in research, education, patient care or consultantship
with Non-U.S. institutions, laboratories or organizations?
Yes
No
2. If Yes, please provide the following information: ("Degree of Collaboration" may be judged by the
frequency/lengths of stay; exchange of students; joint publications, etc.)
Type of Collaboration:
Research
Education
Patient Care Other
City/Country:
University/Institution
Name of Collaborator/Group
Degree of Collaboration
1(high)
2
3
4
5(low)
Type of Collaboration:
Research
Education
Patient Care Other
City/Country:
University/Institution
Name of Collaborator/Group
Degree of Collaboration
1(high)
2
3
4
5(low)
Type of Collaboration:
Research
Education
Patient Care Other
City/Country:
University/Institution
Name of Collaborator/Group
Degree of Collaboration
1(high)
2
3
4
5(low)
3. If suitable international research, teaching, or patient activities become available, would you
be interested in participating?
Yes
No
4. What barriers to international collaboration have you encountered? Please give us your comments.
Comments/Suggestions:
Thank you.
Emily Brown
International Programs and Services
Harper Student Center-AC 208
E-Mail-Brownem@musc.edu
Fax-843-792-2535
Telephone-843-792-2623
This form was created by Neil Diez-Administrative Support Services-MUSC Harper Student Center-843-792-4830.