Travel Grant Application

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Applicant Information

Name*

First Last

Email*

Phone*

Department*

I am a:*

Other - Please Specify

Mentor Information

Mentor Name*

First Last

Mentor Email*

Mentor Department*

Mentor Campus Phone*

Scientific Meeting Information

Meeting Name*

Meeting Dates*

Meeting Location*

Registration Fee*

Innovation theme of your research

Peer Reviewed?*

Yes

Abstract Title*

Is your abstract a poster presentation?*

Yes

Is your abstract an oral presentation?*

Yes

Has your abstract been accepted?*

Yes

If no, explain when you will receive confirmation.*

https://hdsi.uchicago.edu/

Abstract*

Copy-past the abstract you submitted to the meeting.

Recent qualitative and/or quantitative results obtained since the abstract was written.

Describe the innovation of your work.

Describe the impact of your work on healthcare delivery.*

The following are required to complete your application:

Upload faculty or staff recommendation on their stationary.*

Max. file size: 2 MB.

Upload acceptance confirmation for the meeting.*

Max. file size: 2 MB.

Upload your CV.*

Max. file size: 2 MB.

Applicant Information

Mentor Information

Scientific Meeting Information

The following are required to complete your application:

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Travel Grant Application

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Applicant Information

Mentor Information

Scientific Meeting Information

The following are required to complete your application: