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Max D. Cooper Travel Award Application
  1. First Name(*)
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  2. Last Name(*)
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  3. Email(*)
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  4. Mentor(*)
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  5. What year did you enter the graduate or MSTP program or medical school?(*)
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  6. I am applying for a Max D. Cooper Travel Award to attend the following Scientific Meeting, Workshop/Advanced Course:(*)
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  7. Dates:(*)
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  8. Location:(*)
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  9. Estimated cost of this travel: $(*)
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  10. Are you presenting a poster or talk at the meeting?(*)
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  11. 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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  12. 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.
  13. Upload Application Files(*)
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  14. (*)
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