APPLICATION FOR FASEB MARC MENTORED POSTER/PLATFORM (ORAL) PRESENTERS AT THE EB 2016 CONFERENCE ONLY. You may not apply for a FASEB MARC travel award if you are receiving funding from any other sponsoring organizations. 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.
APPLICATION RECEIPT DEADLINE: FRIDAY, FEBRUARY 12, 2016 – 5:00 PM EDT (No exceptions! Apply early!)
MEETING: EB 2016 - (April 2-6, 2016)
MENTORED POSTER/PLATFORM (ORAL) PRESENTATION TRAVEL AWARD APPLICANT (must be FIRST AUTHOR and presenting at the meeting. We do not fund co-First Authors. The person listed first on the abstract is considered to be the First Author eligible for the travel award.)
Applicant Eligibility Category: (required) (Full-time Students/Postdocs ONLY)
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 Address TEL: Enter Contact Phone# MOBILE: Enter Mobile Phone#
This information is required for follow-up program evaluation data and must be provided by applicant. (Required)
Home Address: Enter Address
City: Enter City State: Enter State Code ZIP: Enter ZIP Code
Email: Enter E-Mail Address TEL: Enter Contact Phone# MOBILE: Enter Mobile Phone#
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1) Have you attended an Experimental Biology (EB) meeting before? (required)
2) Are you an individual from a background or group identified as being underrepresented in the biological and behavioral sciences? (required)
3) Please indicate Underrepresented Group (required)
** If “American Indian/Native American” selected, please specify tribe and provide a copy of tribal affiliation certificate.
TRIBE: (required) Specify Tribe
** If “Other” selected, please specify - (required) Specify Other Ethnicity Or Underrepresented Group
4) Citizenship/Residency Status: (required)
** If “USA Citizen,” provide a photocopy of one of the following: 1) Identification page of your valid USA Passport, 2) Birth Certificate,
Certificate of Naturalization, 4) Certificate of United States Citizenship, or 5) Consular Registration of Birth Abroad Form with this
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.
5) Are you funded by an NSF, NIH or other federally-funded Program at your university?(required) If “YES”, please indicate the type of federal grant: If “YES” and your funding type is not listed, enter grant info/number: Enter Grant Info/Number
6) Final Career/Long-term Terminal Degree Desired: (required)
If “Other” selected, enter other degree: (required) Specify Other
7) Are you planning to pursue a career in biomedical research? (required)
8) What is the total number of days you are planning to attend the meeting? (required)
9) Are you a FASEB Society Member?
If “Yes,” indicate Society:
10) Are you interested in having your resume/CV critiqued during EB 2016? (required)
11) Are you interested in receiving onsite mentoring from a FASEB MARC Peer/Faculty Mentor during EB2016? (required)
Americans with Disabilities Act- For Applicants Who Self-identified as “Disability: Mental” or “Disability: Physical” as an Underrepresented Group in #3 above: An individual with a physical or mental impairment that substantially limits one or more major life activities is eligible to apply for this travel award. Please list any disabilities that would require reasonable accommodation and the attention of the program organizers. List any devices/services that would enhance your ability to participate in the FASEB MARC structured peer mentoring activities at EB 2016. Please explain in detail.
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MENTORED PRESENTATION PREPARATION WORKSHOP/ACTIVITIES: FASEB MARC will hold a Mentored Presentation Preparation Workshop during the EB 2016 meeting. The workshop will begin on the morning of Saturday, April 2, 2016, and continue with other structured peer mentoring activities throughout the conference. The purpose of the workshop is to provide our poster/oral presenter travel award recipients with opportunities to practice their presentations and obtain feedback from the designated workshop mentors/coaches. Travel award recipients will be assigned an EB 2016 meeting peer/near-peer mentor who will assist the travel award recipients with their presentation practice sessions, in addition to providing other types of formal and informal mentoring and advising during the EB 2016 meeting.
ATTENTION: This is a MANDATORY participation travel award activity. DO NOT apply for this travel award if you do not wish to participate, or are not certain about your ability to participate in this structured mentoring program and activity. If you apply and are approved to receive a mentored poster/platform presenter travel award and later change your mind about participating in the structured mentoring program and activities, your entire travel award will be rescinded and cancelled completely, and you will not be reimbursed for any expenses you have already incurred/or will eventually incur. Please indicate your understanding and acknowledgement of the restrictions and guidelines for this FASEB MARC Mentored Poster/Platform Presenter Travel Award below:
I am applying for the FASEB MARC Mentored Poster/Platform Presenter Travel Award for the EB 2016 meeting. I understand and agree to participate in all mandatory and structured mentoring program activities affiliated with this travel award. (required)
ABOUT THE FASEB MARC MENTORED POSTER/PLATFORM PRESENTER TRAVEL AWARDS: FASEB is offering a limited number of travel awards of up to $1,850) for eligible underrepresented students and postdocs 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 meeting. Original receipts will be required in order to receive reimbursement. The maximum amount to be reimbursed for meeting registration/travel-related expenses is $1,850. The Application Receipt Deadline is FIRM, so apply early! We do not accept piecemeal submissions. Incomplete and/or Late Application Packets will be DECLINED UPON RECEIPT.
TRAVEL AWARD APPROVAL NOTIFICATIONS will be mailed AFTER the published deadline date and after all travel award applications have been received, processed and reviewed. We will not have approvals on a rolling basis.
INDIVIDUALS WHO WISH TO BE CONSIDERED FOR TRAVEL AWARD FUNDING MUST:
1) Be a USA Citizen or a Legal Permanent Resident of the USA. (A copy of one of the following documents will be required to verify proof of US citizen/permanent resident status: USA Passport ID Page, Birth Certificate, Certificate of Naturalization, Certificate of United States Citizenship, Consular Registration of Birth Abroad, or Permanent Resident “green card”.)
2) Advance register for the meeting.
3) Follow abstract submission guidelines. Submit your abstract and appropriate materials by the deadline date for Experimental Biology 2016. NOTE: When you receive your notification letter indicating that your research abstract will be programmed and included as a poster or oral presentation as part of the EB 2016 Program, you may complete the application process by submitting the confirmation letter ASAP, and prior to 14 calendar days before the start of the EB 2016 meeting. Failure to complete this process will void your travel award application.
4) Complete and submit this application form including:
a. A copy of your letter of confirmation of programmed poster/oral presentation (within 48 hours after notification of your confirmed programmed abstract.)
b. A copy of your extended abstract. (See extended abstract sample information available at www.faseb.org/marc/travel.)
c. A letter on departmental letterhead signed by your mentor, chair or dean that affirms your academic student or postdoc status, and requests consideration for a FASEB MARC Mentored Poster/Platform (Oral) Presenter Travel Award for you. Be sure to include the contact information of your mentor, chair or dean.
d. A copy of your current CV/resume including all sources of funding you are receiving/have received.
e. A one-page statement detailing the benefit you will receive by participating in the meeting, in addition to presenting and discussing your research at the meeting.
Extended 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.)
SUBMIT APPLICATION TO: FASEB MARC Program, 9650 Rockville Pike, Bethesda, Maryland 20814-3998; or via eMAIL: . Applicants selected to receive a travel award will be notified by the FASEB MARC Program upon approval of their application.
The FASEB MARC Program is funded by a generous grant from the National Institute of General Medical Sciences, National Institutes of Health. T36 GM008059-32 NCE.
FASEB MARC TRAVEL AWARD APPLICATION CHECKLIST
Completed Travel Award Application FormCopy of Confirmation/Notification of Abstract Acceptance for Meeting Program (See #4 above
regarding abstract submission and confirmation information.)
Copy of Extended Abstract
Letter of recommendation from Mentor, Chair or Dean
(MUST accompany your application packet at time of submission, otherwise your application will be declined
because the packet will be an incomplete submission.)
Copy of current CV/Resume including all sources of funding you are receiving/have received.
One-page statement detailing the benefit you will receive by participating in the meeting.
** 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 Legal Permanent Resident, copy of ‘Green Card’
** If American Indian/Native American, copy of Tribal Affiliation Certificate
If applicable, include disability statement and ADA-related reasonable accommodation request.
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