We appreciate your patience with completing several forms that require similar information. All participants MUST complete this form, and:

Register with the VCU Global Surgery Office

  1. VCU faculty, clinicians, practitioners, trainees, and other non-clinicians:
Please forward any questions, and all relevant attachments to Amanda Jabri, amanda.adair@vcuhealth.org, research supervisor, department of surgery, virginia commonwealth university.
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Applicant Information


Contact Address


Permanent/Home Address (leave blank if same as above)


Global Surgery Track

Education & Training

Undergraduate Education
Medical Education
Internship (if applicable)
Licensing & Certification

Examinations (if applicable)

USMLE Test (please include results for all attempted examinations)
Please enter information into attached document.
Attachment:   [View Image] USMLE test score.xlsx 

Education Commission for Foreign Medical Graduates Certification

Medical Licenses (if applicable)

Please enter information into attached document.

Attachment:   [View Image] Med licenses.xlsx 

Specialty Board Eligibility/Certification

Passport Information
Apply for or renew your passport as soon as possible to avoid expedition fees and to ensure you have proper travel documents in hand prior to travel.

U.S. passports only: https://travel.state.gov/content/travel/en/passports/apply-renew-passport.html

Once received, please contact amanda.adair@vcuhealth.org
Travel Vaccines, Other Relevant Medical Conditions, Dietary Restrictions

See the CDC recommended vaccines for travel to Peru, in addition to your standing vaccine schedule at: https://wwwnc.cdc.gov/travel/destinations/traveler/none/peru

In addition, consider the following:

  • Ciprofloxacin 500mg x 30 tablets - for traveler's diarrhea.
  • Any normally taken medications. There will not be a Walgreens or CVS on every corner if you forget something.
  • Any over-the-counter or as-needed medications you might want in case you get carsick, feel congested, etc. Access to any medications will be limited, so if you need a sleep aid or an antiemetic, plan ahead.
    If you have not already received your vaccinations for your designated country, we strongly suggest obtaining them one month before travel.
    Emergency Contact
    Read the attached Richmond Global Health Alliance Emergency and Safety Plan, and Volunteer Agreement (Assumption of Risk and General Release).

    Questions about this document may directed to richmondgha@gmail.com
    Read the attached Guidelines for Premedical and Medical Students Providing Patient Care
    During Clinical Experiences Abroad
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