Conference Attendance Request Form Current

Conference attendance Request Form

Link: https://forms.feinberg.northwestern.edu/view.php?id=1649949
Request for funding in support of presenting your research at a National, Regional, or Local Meeting as First Author.

This form must be completed a minimum of 6 weeks prior to the conference.

Travel to a conference must be authorized in advance by Liza Rivnay, Assoc. Admin. Director of Student Research. After completing this form will notify you of the status of this request via email. Once notified, the purchasing process may begin. We urge you not to make any conference related purchases prior to getting a confirmation from Liza Rivnay.

Name Name First Last
Net ID
Class Year
Email
Name of Conference
Location of Conference
Please attest that this conference is taking place within the U.S or Canada

Please attest that this conference is taking place within the U.S or Canada I attest to the above Other Other
Conference start date Conference start date / MM / DD YYYY
Conference end date Conference end date / MM / DD YYYY
Title of Presentation
Type of presentation (poster, abstract, etc.)
Name of project mentor:
Email of project mentor:
Please provide the total amount for registration fees for you to attend this conference.
If the conference registration fee is above $500, please provide a brief justification for your attendance.
Please attach a copy of the accepted abstract. Please ensure that your NAME is listed as a first author on the abstract.

Attach Files
Please attach proof of acceptance to the conference.

Attach Files
Are you a RISE student who is using your PD Fund to attend this conference?

Are you a RISE student who is using your PD Fund to attend this conference? Yes No Other Other
ATTESTATIONS
Please attest that

1. You are the presenting first author for your AOSC, MD/MPH, MD/MA or MD/MS project.

2. That you have not received prior funding for conference travel or registration from FSM Student Research. Per policy, eligible students may request funding for one conference only during their tenure at FSM.

3. MSTP Students are not eligible for this funding. Please attest that you are not an MSTP student.

Please attest that

1. You are the presenting first author for your AOSC, MD/MPH, MD/MA or MD/MS project.

2. That you have not received prior funding for conference travel or registration from FSM Student Research. Per policy, eligible students may request funding for one conference only during their tenure at FSM.

3. MSTP Students are not eligible for this funding. Please attest that you are not an MSTP student. I attest to the above I do not attest to the above
4. The mentor overseeing this research has reviewed your abstract and approves of your attendance to this conference.

4. The mentor overseeing this research has reviewed your abstract and approves of your attendance to this conference. I attest to the above I do not attest to the above

Conference Attendance Request Form Current

Conference Attendance Request Form Current

ATTESTATIONS