Medical Student Conference Support Request

Please complete the form below to request financial assistance for attending a conference where you have presented. Please note that funding requests are not processed until after travel has concluded and all travel expenses have been incurred.

If you have any questions, feel free to contact the LSOM Office for Research at somresearch@uthscsa.edu.

Thank you or your interest, and we look forward to supporting your academic and professional development!

Student First and Last Name

* must provide value

E-mail Address

* must provide value

Faculty mentor's name

* must provide value

Conference Travel Date(s):

* must provide value

Are you an in-state or out-of-state student?

In-state students should contact Jennifer Bitoni Hernandez in the Office of Undergraduate Medical Education for assistance at bitoni@uthscsa.edu.

* must provide value

In-state

Out-of-state

reset

Are you currently enrolled as a medical student?

Note: if you are currently on a leave of absence, taking a year out for research or another project, or are an MD/PhD student currently enrolled in your PhD program, you should select "no".

* must provide value

Yes

reset

Are you presenting at the conference?
Note: funding is only provided to support students who are presenting at conferences. Funds will not be awarded for students to attend conferences for professional development.

* must provide value

Yes

reset

Please include the dollar amount you are requesting for travel. Note: funding is limited to $500 per student.

* must provide value

Please upload a single PDF file that includes all receipts for your actual travel expenses. This includes costs such as registration, airfare, hotel, and other travel related expenses. Reimbursements will only be issued for items supported by valid receipts.

* must provide value

Upload file

Please upload documentation of your acceptance to present at the conference. This may be an email or other notification from the conference organizers.

* must provide value

Upload file

Please upload your poster/abstract/other conference materials.
Note: these materials should include a full author list.

* must provide value

Upload file

Please upload a justification for attending the conference and a detailed description of the benefit to your career/education.

* must provide value

Upload file

Please upload a brief and generic "thank you letter." The UME Office will utilize this letter to share with donors who make funding possible.

* must provide value

Upload file

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.