Department of Surgery Medical Student Travel Award Application Form

Future Students

Undergraduate Students

Graduate Students

Parents & Family

Alumni

Faculty & Staff

Researchers

Patients

Colleges & Schools

Name(*)

Please enter your name.

Blazer ID(*)

Please enter your Blazer ID.

Are you currently a medical student enrolled at UAB?(*)

Yes

Please indicate whether you are a medical student at UAB.

If no to above, were you a STREAMS T35 trainee?

Yes

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Email Address(*)

Please enter your email address.

Mentor Name(*)

Please enter the name of your mentor.

Name of Meeting (Please only select one.):(*)

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If you selected other, please type the name of meeting or conference.

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If you selected other, please upload documentation that you applied to HSOM PSDO and your request was declined.

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Meeting Dates(*)

Please enter your meeting dates.

Meeting Location(*)

Please enter your meeting location.

Abstract Title and Author List(*)

Please enter your abstract title and author list.

Have you had a prior trip paid for by the Department of Surgery in the current calendar year?(*)

Yes

Please indicate whether you have had a prior trip paid for by the Department of Surgery.

Have you received travel funds from another source in support of the trip for which you are submitting this application?(*)

Yes

Please indicate whether you have received travel funds for this trip from another source, besides the UAB Department of Surgery.

If yes, who was the source of these funds and how much did you receive from them?(*)

Please name the source of your additional funding and how much you received as part of that funding.

Complete the following form.

TRAVEL PRE-APPROVAL FORM

Please upload your completed UAB Travel Pre Approval Form(*)

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Please upload a copy of your abstract acceptance.(*)

Please upload a copy of your abstract acceptance.

(*)

Please indicate that you are not a robot.