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Physician Scientist Development Office

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Physician Scientist Development Office

UAB Heersink SOM Medical Student Travel Award Application

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Click here to Download the UAB Pre-Travel Approval Form.  This form must be signed by your mentor and attached prior to award review. The Dept of Med Ed will sign the form once the travel award has been reviewed and approved. 
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Research Support

What research program supported the research that is described in this abstract (select all that apply)
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Faculty Mentor *related to abstract submission

Your mentor will receive a request with a copy of your abstract asking if he/she approves of your abstract submission. If applicable, your mentor will need to provide a letter of support to help offset additional expenses not covered by the UAB Heersink SOM Travel Award. All additional expenses will be your responsibility unless otherwise noted in the award notification.

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Abstract Submission

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MSTA Request Submission: 30 Days prior to conference. Late applications may not be considered for an award. If granted a UAB Heersink SOM MSTA, Reimbursement processing due no later than 30 days after commencement of conference travel This award is not guaranteed and is subject to approval. Please keep this in mind when making travel arrangements
IF YOU ARE APPLYING FOR THE UAB HEERSINK SOM MEDICAL STUDENT TRAVEL AWARD

I agree to the following "Statement of Agreement":

1. As a medical student travelling with financial assistance from the University of Alabama at Birmingham (UAB), Physician Scientist Development Office (PSDO), and Associated Partners within the UAB Heersink SOM, I do, by statement of agreement, acknowledge and understand that the UAB Heersink SOM is intending to support the educational benefits of this event.

2. The expectation is that I will use these funds to attend the conference meetings, participate in the conference, and contribute to the conference aims. I understand I am a representative of my program, UAB, UAB Heersink SOM, and the UAB PSDO, and I agree to exemplify the professional nature of the University while on my travels.

3. I also agree that UAB, UAB Heersink SOM, and UAB PSDO will not be held liable for any damages to persons or property related to this travel.

4. By agreeing to the Medical Student Travel Award application, I indicate that:

a. I am an actively enrolled medical student with good academic standing in the UAB Heersink SOM.

b. I have read and understood the UAB Heersink SOM Medical Student Travel Award Reimbursement Requirements listed on the PSDO website.

c. I understand that failure to conform to the policies and guidelines of this document as well as the UAB Financial Affairs Department could result in rejection of my travel reimbursement and/or loss of eligibility for future UAB Heersink SOM travel funding.

d. I understand that providing false information to the UAB Heersink SOM and UAB PSDO is a violation of the UAB Honor Code and could result in disciplinary action and/or dismissal from the University.

e. I understand that my elgibilty for the UAB Heersink SOM Medical Student Travel Award may be limited to one award per UAB Heersink SOM Academic Year.

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