HIMB Registration Form
If you are visiting HIMB to conduct research, intern or volunteer with HIMB researchers, or participate in a workshop or retreat, you are required to fill out this form. If you are HIMB faculty, staff, post-doc, or grad student, DO NOT fill out this form. Please contact Jen Davidson (jdav@hawaii.edu) if you have any questions or concerns.
Who is your HIMB sponsor? *
HIMB sponsor email address *
Your answer
Your First Name *
Your answer
Your Last Name *
Your answer
Your Email *
Your answer
Cell Phone *
Where you can be reached while at HIMB (in case of emergencies). Example Format: 808-555-1212 or +44-123-1234567
Your answer
Purpose at HIMB *
If "Other", please explain here
Your answer
Home Institution / School *
Your answer
Country *
Your answer
State *
Date requested for arrival *
MM
/
DD
/
YYYY
Anticipated date of departure *
NOTE: If you will be on island totaling more than 15 days (not necessarily consecutive) within any calendar year, you MUST submit Tuberculosis clearance in accordance with Administrative Procedure A9.520
MM
/
DD
/
YYYY
Will you be at HIMB for more than 15 days? *
If yes, you are REQUIRED to get a TB test.
Members of your team *
If you have collaborators or research assistants who will accompany you, please list their names and have them submit individual Visiting Researcher Registration Forms (Section 1 only). Please put "N/A" if you are not part of a team.
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of University of Hawaii. Report Abuse