Proposal for Agreement or Partnership Form

About you (the potential partner)

Institution and Country

Contact person

Position/Title

Department/Unit

Email

Phone Number

Please provide any additional information about your institution or department that may be helpful in understanding and evaluating your request for partnership (e.g. international reputation, strategic goals and priorities, etc.)

Areas of Collaboration (check all that apply)

Clinical

Research

Academic

Student and/or Faculty mobility

Other (please specify)

Describe the objectives of the partnership proposal and how they might be aligned with the objectives of the Faculty’s strategic goals and priorities? Are the objectives aligned with uOttawa strategy and direction?

This partnership involves (check all that apply)

Faculty of Medicine only

An individual Faculty member in a clinical or basic science department, laboratory, institute or centre

University of Ottawa at large

Several faculties from uOttawa

Researchers

Staff

Students

Other

Provide details on the disciplines, programs or faculties concerned

Have you already contacted individuals at the Faculty of Medicine to discuss this proposal? If so, list them here (name, position, department/faculty).

Did you have any collaboration projects with our Faculty in the past? If yes, please indicate the type of activity and the name of the individual(s)/departments you collaborated with

Yes

Leave this field blank

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