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Travel Award Form

MSR Travel Award Submission/Approval

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Students are eligible to receive the MSR Travel Award only once; please be selective on when and where award is used. The award will be up to 50% of the total cost of the trip, with a maximum award of $500. You must have submitted your final MSR report to be eligible for a travel award.
Student Information




Medical Student Research Project Information


Description and Purpose of Travel



What conference are you going to, how are you presenting, etc. Please include the full name of the conference which you are planning to attend, not just the acronym or abbreviation.



Advisor for Travel Opportunity




Other funding
Please list all other funding sources you've applied for. (At a minimum, you must have requested funds from the department sponsoring your travel.)




Estimated Expense
Please include the estimated amount for each section, rounded to the nearest dollar, without the dollar sign (e.g., "100" for a $100 cost).
Transportation




Subsistence









Students are eligible to receive the MSR Travel Award only once; please be selective on when and where award is used. The award will be up to 50% of the total cost of the trip, with a maximum award of $500.
Agreement
I understand that I will provide my ORIGINAL itemized receipts within two weeks of returning from my approved trip in order to receive reimbursements, and that the final reimbursement amount is dependent upon the actual receipts submitted not to exceed the approved amount.

Typing your name and submitting this form electronically serves in lieu of a signature.