APPLICATION FOR POSTER OR PLATFORM (ORAL) PRESENTERS AT THE FASEB SCIENCE RESEARCH CONFERENCES ONLY. You may not apply for a FASEB MARC travel award if you are receiving funding from any other source related to the FASEB SRCs. The travel award is not transferable without proper documentation and authorization.

DEADLINE INFORMATION: All applications for FASEB MARC/SRC Travel Awards must be received at least six weeks prior to the start date of the selected SRC. Late and/or incomplete applications will not be processed.

Please provide the Science Research Conference information requested below:

SRC Date (June 2013):

SRC Date (July 2013):

SRC Date (August 2013):

SRC Web ID Number: Enter Web Id Number (12345-023)

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

Applicant Eligibility Category: (Jr. Faculty, Postdoc, Advanced Graduate/PhD Student ONLY)

Name: Enter First and Last Name

Gender: Degree/Title:

Institution: Enter Institution's Name Department: Enter Department

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#

Home Address: Enter Address

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

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

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

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 with this application.

** If “Permanent Resident of USA,” provide a copy 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 NIH, NSF or other federal grants at your university?
  2. Have you ever attended a FASEB Summer/Science Research Conference?
    If “Yes”, how many times? Enter Number Attended
  3. Are you a FASEB Society Member?

If “Yes,” indicate Society:

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

If “Yes,” indicate Society:

ABOUT THE FASEB MARC TRAVEL AWARDS: FASEB is offering a limited number of travel awards for underrepresented non-tenured junior faculty, postdoctorates and advanced graduate students to help defray meeting registration and travel-related expenses associated with FASEB Science Research 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 will be indicated in the travel award recipient’s award letter.

ADVANCED GRADUATE STUDENTS, POSTDOCTORATES AND JUNIOR FACULTY (NON-TENURED) 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)Advance register for the conference. Follow abstract submission guidelines.

3)Submit your abstract and appropriate materials by the deadline date for the meeting you are applying for. NOTE: Please submit your FASEB MARC/SRC Travel Award Application to FASEB MARC Program after you have received notification of your acceptance/registration for the FASEB SRC. Travel award applications received from applicants who have not registered for the FASEB SRC will not be processed.

4)Complete and submit this application form including:

  1. A copy of your accepted FASEB SRC abstract.
  2. A copy of your FASEB SRC registration.
  3. 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.
  4. A current copy of your CV/resume (including all sources of funding you receive/have received)

All travel award applicants must register for a FASEB SRC prior to applying for the travel award. 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.) In addition, preference will be given to new/first-time FASEB SRC Travel Award applicants. 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-Career Resources, 9650 Rockville Pike, Bethesda, Maryland 20814-3998; Tel: 301-634-7021; 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

TRAVEL AWARD APPLICATION CHECKLIST

Completed Travel Award Application Form
Copy of Notification of Abstract Acceptance for Conference Program
Copy of Confirmed Conference Registration the FASEB SRC
Copy of Accepted/Programmed Abstract
Letter of recommendation from Mentor, Chair or Dean
(MUST accompany your application packet, otherwise your application will be declined.)
Copy of CV/Resume including all sources of funding you receive/have received
** 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,

ALL INCOMPLETE AND/OR LATE APPLICATION PACKETS

WILL BE DECLINED UPON RECEIPT.