Student Travel & Publication Funding Request Form » Office of Educational Affairs » College of Medicine

Applicant Information
Name*
Date of Request*
Class Year*
Phone*
Home Address*
Please enter the address where you are currently recieving mail. This information is entered into the travel system so that you can be reimbursed.

Street Address Address Line 2 City State ZIP Code
Email*
Research Mentor Information
Mentor Name*
Mentor Department*
Mentor Email*
Letter of Support from Research Mentor*
Conference and/or Publication Information
Conference and/ or Publication Name*
Conference Date(s) or Publication Date*
Conference Location ( City and State)*
Educational Purpose*
Is this event related to a student organization?*
- Yes
- No
If yes, which organization?*
Are you receiving any additional funding support from a UF division? (For example, is another department paying for any part of this trip).*
- Yes
- No
If yes, please provide department name, contact person, and email.*
Research Presentation Information
Research Abstract and/or Poster*
Additional Documents (if necessary)
Untitled

Applicant Information