APPLICATION FOR POSTER/PLATFORM (ORAL) PRESENTERS ONLY. You may not apply for a FASEB MARC travel award if you are receiving funding from any other sponsoring Societies. Travel Award is not transferable without proper documentation and authorization.Applicants must NOT at any time be staffing an exhibit booth at the meeting. Violation of this policy during the meeting will invalidate your travel award.

DEADLINE INFORMATION for submittal of FASEB MARC Applications is listed on the FASEB Eligible National Scientific Meetings page.

Please indicate the scientific meeting that you are requesting travel support for (select only one):

JULY – DECEMBER 2011 >

Are you a FASEB-sponsored SROP Student/Post-bac?

POSTER/PLATFORM (ORAL) PRESENTATION TRAVEL AWARD APPLICANT (must be FIRST AUTHOR and presenting at the meeting.)

Applicant Eligibility Category:

Name: Enter First and Last Name

Gender: Degree/Title:

Home Institution: Enter Institution's Name Department: Enter Department

Home Institution Address: Enter Address

City: Enter City State: Enter State Code ZIP: Enter ZIP Code

EMail: Enter E-mail AddressTEL: Enter Contact Phone# MOBILE: Enter Mobile#

  1. Are you a member of an ethnic minority group identified as being underrepresented in the biological and behavioral sciences?
  1. Please indicate Race/Ethnicity (required):

** If “American Indian/Native American,” please specify tribe and provide a copy of tribal affiliation

certificate. TRIBE: SPECIFY TRIBE

** If “Other,” please specify -SPECIFY OTHER

  1. Citizenship/Residency Status:

** If “USA Citizen,” provide a photocopy of one of the following: 1) Identification page of your valid USA Passport,

2) Birth Certificate,3) Certificate of Naturalization, 4) Certificate of United States Citizenship, or 5) Consular Registration of

Birth Abroad Form withthis application.

** If “Permanent Resident of USA,” provide a photocopy of your “Green Card” with this application.

NOTE: The above documents are requested for verification purposes only. After citizenship or permanent residency status

has been confirmed by FASEB MARC Program staff, the documents are destroyed through a secure shredding process.

  1. Are you funded by an NIGMS/NIH-sponsored MARC Program at your university?
  1. Final Degree Desired: If “Other” selected, enter other degree:
  1. Are you planning to pursue a career in biomedical research?
  1. Have you ever worked in a research laboratory as a summer intern or in a paid position? If “Yes,” how many times?
  1. Are you a FASEB Society Member?

If “Yes,” indicate Society:

If “No,” would you like to be contacted by a FASEB Society?

If “Yes,” indicate Society:

ABOUT THE FASEB MARC TRAVEL AWARDS: FASEB is offering a limited number of travel awards of up to $1,650 for each postdoctorate and undergraduate/graduate student to help defray meeting registration and travel related expenses associated with meeting/conference attendance. These funds are meant to defray meeting registration, air, ground, lodging/subsistence expenses only. NOTE: Travel awards are processed as reimbursements after the meetings. Receipts will be required in order to receive reimbursement. The maximum amount to be reimbursed for meeting registration/travel-related expenses to be reimbursed is $1,650.

POSTDOCTORATES, POST-BACCALAUREATES AND STUDENTS WHO WISH TO BE CONSIDERED FOR TRAVEL AWARD FUNDING MUST:

1)Be a USA Citizen or a Permanent Resident of the USA. (Copy of USA Passport ID Page, Birth Certificate, Certificate of Naturalization, Certificate of United States Citizenship,Consular Registration of Birth Abroad, or Permanent Resident “green card’ will be required.)

2)Submit your abstract and appropriate materials by the deadline date for the meeting you are applying for.

3)After you have been notified of acceptance of your abstract by the meeting officials, complete and submit this application form including:

  1. A copy of your notification of acceptance letter of your research abstract, plus a copy of your accepted abstract.
  2. A letter on departmental letterhead signed by your mentor, chair or dean that affirms your postdoctoral or student status, and request consideration for a FASEB MARC Poster/Platform (Oral) Presenter Travel Award. Be sure to include the email address and daytime phone number of your mentor, chair or dean.
  3. A current copy of your CV/resume.

Abstracts submitted and accepted as poster or platform (oral) presentations will be used as the basis for the awards. The FASEB MARC Program review committee will select the award recipients based on the accepted scientific abstracts of applicants who are eligible for MARC funding as specified by the National Institute of General Medical Sciences, National Institutes of Health (NIGMS/NIH.)

Applicants selected to receive a travel award will be notified by the FASEB MARC Program upon approval of their application.

SUBMIT APPLICATION TO: FASEB MARC Program, 9650 Rockville Pike, Bethesda, Maryland 20814-3998; Tel: 301.634.7109; FAX: 301.634.7353; eMAIL: ; Internet:

The FASEB MARC Program is funded by a generous grant from the National Institute of General Medical Sciences, National Institutes of Health.T36-GM008059-29.

TRAVEL AWARD APPLICATION CHECKLIST

Completed Travel Award Application Form
Copy of Notification of Abstract Acceptance for Meeting Program
Copy of Accepted/Programmed Abstract
Letter of recommendation from Mentor, Chair or Dean
(MUST accompany your application packet at time of submission, otherwise your application will be will be declined because the packet will be an incomplete submission.)
Copy of CV/Resume
** If USA Citizen, copy of USA Passport ID Page, Birth Certificate, Certificate of Naturalization,Certificate of
United States Citizenship, or Consular Registration of Birth Abroad
** If Permanent Resident, copy of ‘Green Card’
** If American Indian/Native American, copy of Tribal Affiliation Certificate

PLEASE BE ADVISED:

WE DO NOT ACCEPT PIECEMEAL SUBMISSIONS.

ALL INCOMPLETE OR LATE APPLICATION PACKETS

WILL BE DECLINED UPON RECEIPT.