DEPARTMENT OF ORGANISMIC AND EVOLUTIONARY BIOLOGY
HARVARD UNIVERSITY
FIELD RESEARCH PLAN
Please file this field research plan with your advisor and with the OEB Admin Office
Name:
Phone No:
Email:
Advisor:
Dates of Travel:
Location of Field Research:
Country:
Geographical Site:
In-Country Contact Phone No:
(Personal cell phone no. or other no. you can be reached at)
Nearest City:
(Name, Distance from site)
Nearest Hospital:
(Location, Distance from site)
Field Research: (Please include a brief description of the field work)
Emergency Contact:
Name:
Relationship:
Phone Number(s):
In case of emergency I grant OEB/Harvard University permission to contact the person above.
By checking each box below I certify that I have:
Obtained the necessary collecting, import, and export permits (If applicable)
Created a Personal Travel Record and Emergency Record with International SOS
Consulted a Travel Clinic regarding immunizations and medications.
HUHS Travel Clinics (Holyoke Center 5-5182 or Law School 5-4414)
Attached copies of my passport, visa(s), and airline travel itinerary to this document.
Signature: __________________________
Date:___________________