Resident/Fellow Travel Grant Request Form

Programs may request assistance with resident/fellow travel to conferences for approved presentations (i.e. posters, abstracts, workshops, etc.) in amounts up to $2,000.

Funds for the resident/fellow conference travel grant are based on foundation donations. Travel grants are reviewed for approval and then awarded on a first come-first served basis until no funds remain.

Nominations for the travel grants should be made by the program director or program coordinator. Please provide as much detail as possible in the text boxes below. Programs will receive an email from the COM GME Office regarding approval of the request. If you have any questions, please contact askGME@uams.edu.

Nominated by:

Name(Required)

First Last

Nominee Information

Name(Required)

First Last

Program(Required)

PGY Level(Required)

Presentation Information

Presentation Type (i.e., abstract, poster, workshop)(Required)

Conference Name(Required)

Conference Start Date(Required)

Conference End Date(Required)

Amount Requested(Required)

Flight Estimate(Required)

Hotel Estimate(Required)

Meals Cost Estimate(Required)

Program Department Contribution Estimate(Required)

Provide email documentation of presentation acceptance.(Required)

Max. file size: 15 MB.