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Required format:

LaCamera Oncology Travel Award Application Form

Returning?

A A A

Please complete the form below to apply for domestic travel support, maximum of $1500, to a Cancer-focused medical or research conference.

Thank you!

First name

* must provide value

Middle name or initial

Last name

* must provide value

Are you currently a medical student at the University of Colorado School of Medicine?

* must provide value

Yes

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What year of medical school training are you in?

* must provide value

First year

Second year

Third year

Fourth year

Other (explain below)

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Explain what "other" year of medical school training you are in.

Who is your primary research mentor?

* must provide value

Name of the cancer-related conference you are attending and requesting travel support for

* must provide value

Please provide the web link to the conference

* must provide value

Conference location. Please list city and state.

* must provide value

Conference dates. Include month, day(s) and year

* must provide value

Funding amount requested (in US dollars)

* must provide value

What expenses will these funds be used for (i.e. airfare, lodging, meeting registration, meals etc...)?

* must provide value

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Are you presenting or are you involved in organizing an activity at this conference?

* must provide value

Yes

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Please describe your participation at the conference (attendee, poster or oral presenter, panelist, organizer etc.)

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Describe specifically what you will do at the conference that is cancer-focused and how it will enhance your medical training in the field of oncology.

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Have you been supported by the Cancer Center for any training or academic activities in the past?

* must provide value

Yes

I'm not sure

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Describe how you were supported by the Cancer Center in the past.

Gender

* must provide value

Race/Ethnicity

Select all that apply.

* must provide value

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latinx

Native Hawaiian or Other Pacific Islander

White or Caucasian

Other-not listed

Prefer not to disclose

If you selected "other-not listed" for your race/ethnicity, would you like explain?

Do you have a disability as defined by the NIH (category B)?

The NIH defines those with a physical or mental impairment that substantially limits one or more major life activities as described in the American Disabilities Act of 1990.
For more information see https://grants.nih.gov/grants/guide/notice-files/NOT-OD-20-031.html

* must provide value

Yes

Prefer not to disclose

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Are you from a disadvantaged background as defined by the NIH (category C)? For more information see https://grants.nih.gov/grants/guide/notice-files/NOT-OD-20-031.html

The NIH considers individuals to be from a disadvantaged background if they meet or have ever met TWO OR MORE of the following criteria:

* Were or currently are homeless, as defined by the McKinney-Vento Homeless Assistance Act (Definition: https://nche.ed.gov/mckinney-vento/).

* Were or currently are in the foster care system, as defined by the Administration for Children and Families (Definition: https://www.acf.hhs.gov/cb/focus-areas/foster-care).

* Were eligible for the Federal Free and Reduced Lunch Program for two or more years (Definition: https://www.fns.usda.gov/school-meals/income-eligibility-guidelines).

* Have/had no parents or legal guardians who completed a bachelor's degree (see https://nces.ed.gov/pubs2018/2018009.pdf),

* Were or currently are eligible for Federal Pell grants (Definition: https://www2.ed.gov/programs/fpg/eligibility.html).

* Received support from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) as a parent or child (Definition: https://www.fns.usda.gov/wic/wic-eligibility-requirements).

* Grew up in one of the following areas: a) a U.S. rural area, as designated by the Health Resources and Services Administration (HRSA) Rural Health Grants Eligibility Analyzer (https://data.hrsa.gov/tools/rural-health), or b) a Centers for Medicare and Medicaid Services-designated Low-Income and Health Professional Shortage Areas (qualifying zip codes are included in the file).

* must provide value

Yes

Prefer not to disclose

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