UW-Madison Institute on Aging 23rd Annual Colloquium
Tuesday, October 11, 2011,8:30 am to 1:30 pm, at Monona Terrace in Madison, WI

APPLICATION FOR POSTER SESSION & NEW INVESTIGATOR AWARD

TO COMPLETE APPLICATIONemail the following by Monday, August 1, 2011to :

AllApplicants: ● Send this application &a research abstract,not to exceed 250 words, that includes the following, as appropriate, about your poster: the problem being investigated, the sample, research methods, data analysis, resultsimplications.

PosterApplicants:●Complete onlySection 1 of this application

Award Applicants: ● Complete Section 1 and 2 of this application

●Also senda letter of recommendation from faculty advisor/mentor

______

______SECTION 1: ALL APPLICANTS______

Applying for: poster session only poster session and award (see eligibility below)

Applicant Information:

Applicant Name:

Department:

Campus Address:

Work Phone: Home Phone:

Cell phone: E-Mail:

UW-Madison Statuswhen work was completed (must be during academic years 09/10, or 10/11, 11/12):

Faculty/Staff Graduate or Medical Student UndergraduatePostgraduate Trainee

Postdoctoral Fellow, Trainee, Project/Research Associate Other:

Colloquium Registration: If your poster is accepted, you will be automatically registered for the event. Please indicate your preference for the free box lunch that is included: meat vegetarian

Poster Details: Note that the poster should report new scientific findings and its title and text should
becomprehensible to the general public. Please make an effort to translate highly technical language and procedures so that non-researchers(who are the majority of our attendees) can understand your work. Provide the following, which will be included in the event handouts:

Poster Title (comprehensible to the public):

Author(s):

Poster Category (choose only one): Biomedical PsychosocialClinical/Applied

Poster Size: My poster will fit in the available space: 7’ 7” wide by 3’ 8-3/4” high (91” x 44.75”)

My poster is wider (specify width: ) will need extra space(taller posters cannot be accommodated)

Poster Printing: I wantto print my poster for free on the IOA poster printer(Must be print ready in PDF

format & no larger than 91" wide by 43" high. IOA cannot help with design or layout.NOTE:

Posters printed by IOA are also posted on our website, unless you request otherwise.)

I will not be printing my poster on the IOA printer

SECTION 2: NEW INVESTIGATOR AWARD APPLICANTS

Complete the following only if you would like to apply for an Award:

(also complete Section 1 on the previous page)

Award Eligibility & Rules:

●Applicants must be UW-Madison students or advanced trainees (including undergraduates; graduate & medical students; postgraduate trainees; and postdoctoral fellows, trainees, or project/research associates). Faculty/staff are not eligible. Indicate your status in Section 1 above.

●Applicants must provide a letter of recommendation with a handwritten signature from their faculty advisor/mentor that includes a statement that the work is substantially the applicant’s own research.

●Work must be completed during academic years 09/10, 10/11, or 11/12.

●Applicant must be available to attend the Colloquium (date & time are on previous page) in order to present their work in poster format and be available for the award presentation.

●Award selections are made by a team of IOA Affiliates, based on the quality of the research and its relevance to the study of aging, as evidenced in the submitted abstract (you do not need to submit your finished poster to the judges).

●Previous winners are not eligible to apply.

Applicant Name:

Faculty Advisor/Mentor Contact Information:

Name & Title:

Department:

Campus Address:

Work Phone: Cell Phone:

E-Mail:

Letter of recommendation from faculty advisor/mentor completed according to the above instructions:

is attachedwill be sent separately (If the letter cannot be emailed with

signature, it can instead be faxed, mailed, or dropped off so that it arrives

at IOAby the deadline. See contact info below.)

Thank you for applying!

Completed application should be emailed by August 1, 2011 to .

Please contact us if you do not receive an email acknowledging your application.

You should be notified by late August or early September

regarding acceptance of your poster and/or award status.

For questions, contact: Theresa Berrie, 2245 MSC, 1300 University Ave., Madison, WI 53706

(608) 261-1493 ● fax (608) 263-6211 ● ●