Test form Faculty Travel Award Application Personal InformationName* First Last UF Email* Department*NeuroscienceNeurosurgeryNeurologyPsychologyOther deptartment in College of MedicineOther department outside of College of MedicineCenter / Institute*N/ACARECTRNDCMDNRCAM-CTRPConference / Travel InformationName of Conference* Location* Conference website link* Conference start date* MM slash DD slash YYYY Conference end date* MM slash DD slash YYYY Title of Presentation* Co-authors*Presentation type*Oral / PlatformOther w/ press releaseWrite a brief description (less than 300 words) about the conference, speaking opportunity and benefit to individual career.*Requested Travel Budget (not to exceed $3,000)*RegistrationAirfareOther (parking, taxis, tolls)TOTAL Submit the abstract, oral presentation, or an explanation of the research you will present.*Max. file size: 125 MB.Submit confirmation that your submission is accepted for presentation*Max. file size: 125 MB.Submit your budget and includes other sources of travel funding (including any offered by the conference organizers).*Max. file size: 125 MB.Application AgreementSignature*I certify that all information provided on this application is complete and accurate to the best of my knowledge. I understand any false statements or untruths will result in my forfeiture of the award should I be selected as a recipient and my returning any/ all MBI Travel Award monies awarded to me. I understand that no personal travel is authorized related to this award. Funds may only be used for my expenses, and not the expenses of others. I understand the award is forfeited if the event or my travel is cancelled or changed for any reason, or if I do not present my work for any reason. I agree that if awarded, I will acknowledge the MBI support at my presentation and on all related materials. CAPTCHA
