Max D. Cooper Travel Award Application

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Max D. Cooper Travel Award Application

First Name(*)

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Last Name(*)

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Email(*)

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Mentor(*)

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What year did you enter the graduate or MSTP program or medical school?(*)

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I am applying for a Max D. Cooper Travel Award to attend the following Scientific Meeting, Workshop/Advanced Course:(*)

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Dates:(*)

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Location:(*)

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Estimated cost of this travel: $(*)

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Are you presenting a poster or talk at the meeting?(*)

Poster

Talk

N/A

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In addition to my application for a Max D. Cooper Travel Award, I plan to apply for funding from the following sources:(*)

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Application submissions must be in PDF format:
• Approval letter from mentor
• CV
• Meeting abstract or course information (250 words maximum)
The application packet must be submitted as a single PDF.

Upload Application Files(*)

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(*)

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Max D. Cooper Travel Award Application