Presentation Award Request Form

Office of Student Research
Office of Student Affairs
Bressler, Suite M-019
655 West Baltimore Street
Baltimore, MD 21201
StudentResearch@som.umaryland.edu

Presentation Award Request Form

Presentation awards are designed to help offset a portion of the cost of attendance and travel for students who will present their research at a national or international conference (up to $400). Funds are limited each year and are available on a first come, first served basis.

Be sure to review the full eligibility list on the OSR website and complete all three sections below to request presentation funding.

Please allow up to two weeks for a response from OSR regarding whether your funding request has been approved, denied, requires more information. If your request for funding is approved, you will be asked to submit additional documentation, including your W9.

1. Student & Mentor Information
Student Name*

First NameLast Name
Class Year*
SOM Email*
example@som.umaryland.edu
Primary Mentor Name*

First NameLast Name
Primary Mentor Email*
example@example.com
Primary Mentor Department (and institution if not UMSOM or UMMC) *

2. Presentation Information
Full Conference Name*
Conference Location (Virtual or, if in-person, city and state)*
Dates of Conference*
Presentation Date(s)*
Presentation Type*

OralPoster
Title of Presentation and Abstract
Please upload proof of acceptance of the presentation at the conference (confirmation email or letter from the conference or hosting institution)*

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Please upload proof that you will present at the conference (e.g. a copy of your response to the email or letter, copy of your registration confirmation, copy of your confirmed presentation schedule, etc.)*

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3. Funding Request
I am seeking funds to support with*

The cost of registering to attend the conference.The cost of traveling to the conference, if the event is both 1) hosted in person and 2) located more than 60 miles from UMB.
Cost of Conference Registration Fee
Estimated Travel Expenses
Breakdown of Travel Expenses
Please upload receipts or proof of estimated expenses*

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Do you plan on receiving or applying for any additional sources of funding to cover the conference costs? If so, please describe.*
Please confirm that your funding request meets all of the following criteria*

I will be the primary presenter of an original research projectThe work will be presented at a national or international conferenceI have not received another OSR Presentation Award this year (July 2022 - now)The presentation resulted from research conducted while enrolled in UMSOM

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