Form 3: GLEON Student/Host Agreement

Complete with as much detail as possible, including how the logistics will be arranged, costs, and who is responsible for each item.

A. Summary Information

Name of Student Visitor*

Institution of Student Visitor*

Name of Host*

Institution of Host*

Dates of visit (MM/DD/YYYY)*

through (MM/DD/YYYY)*

B. Domestic Agreements

1. Housing*

2. Food*

3a. Transportation to and from the host site*

3b. Local transportation*

4a.Total request ($US dollar)*

4b. Other funding available*

C. Research Agreements

1. Skill acquisition/research experience expectations*

(i.e. is the goal of the exchange a research project, learning a specific skill, etc.)

2a. Who will be the primary mentor for the student?*

Note: The on-site mentor must be available and accessible to answer questions and guide the student at the host institution; this person may or may not be the same individual as the host prinicipal investigator.

3a. Equipment/supplies/computer provided by host*

3b. Equipment/supplies/computer provided by student*

4a. Lab/working space for student*

4b. Sample storage space/special storage conditions*

5. How will intellectual property ownership be handled?*

D. Miscellaneous

1. Samples transport to/from the host site*

(number of samples, cost of shipping, responsible parties, and international policies of sample transport)

2. Travel logisitics*

(visa requirements and costs, airplane tickets, field permits, etc.)

E. Signature of Agreement

By entering your name below, you agree to the conditions stated above. If this contract is broken, you or your host may submit a written complaint to the GLEON Review Board where complaints will be reviewed on a case-by-case basis.

*Note: Your host will be contacted by the GLEON Program Coordinator to verify agreement.

Student Name*

Student Email*

Host Name*

Host Email*

Date (MM/DD/YYYY)*