Intake Form: UMN-affiliated Visitors in Uganda
Please complete this form if you require services from the UMN Hub in Uganda or if you will be working in collaboration with UMN-led research and training activities. If you're not sure if you should complete this form, you can contact Molly McCoy at mccoy019@umn.edu or 612-626-3280.

We prefer that you complete this form at least two weeks before you travel, but you may submit it as early as 6-9 months in advance. Lodging is granted to eligible UMN affiliates on a first-come, first-served basis so it is to your benefit to request this early. If your request is received very close to your travel dates, we cannot guarantee that we will be able to provide all services or support required.

Email address *
Name
Your answer
Please select your affiliation/status
What is your UMN College and Department? If you are a student, what year are you in your degree program (ie: first year MPH or med student)
Your answer
Students/Residents: who is your faculty mentor or advisor overseeing your work in Uganda?
Your answer
When do you arrive in Kampala (date)
MM
/
DD
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YYYY
When do you leave Kampala (date)
MM
/
DD
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YYYY
What is the purpose of your travel to Uganda?
Please indicate any services you wish to request:
Please let us know any specific information needed to assist with this request (ie: flight info including date and time of arrival, meeting needs, other requirements)
Your answer
Please check the following to indicate you have reviewed and/or will obtain approval for each item prior to travel:
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