MSRO Conference Travel Funding Application

MSRO Conference Travel Funding Application
Medical students can apply to receive up to $1,500 for research-related conference travel per academic year (July 1 – June 30). Students can submit up to two requests per year (for a combined maximum of no more than $1,500).

Eligibility
- Medical students are eligible for conference funding if they are presenting their research, either as first author or co-author
- The research that is being presented must have been performed during the student’s medical school years
- Only conferences within the US are eligible for funding. Conferences in Canada will be considered on a case-by-case basis.
This application must be submitted at least 2 weeks before the conference start date. Late submissions will not be accepted.

For more information and details, please reference the MSRO Conference Travel Funding Guidelines.
Student Information
Student Name*

First NameLast Name
Mount Sinai Email*
example@icahn.msmm.edu
Life Number*
You can find your life number on your ID badge
Phone Number*
Program*

MDMD/PhD, currently in MD phaseMD/MPHMD/MSCR
Class Year*

M1M2M3M4Scholarly YrOther
Conference Details
Name of Conference*
Conference Location*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Conference Start Date*

MonthDayYear
Conference End Date*

MonthDayYear
How will you be attending the conference?*

I am planning to travel to the conferenceI am planning to attend virtually
Estimated Travel Departure Date*

MonthDayYear
If your departure date is not certain yet, choose the earliest date you might leave
Estimated Travel Return Date*

MonthDayYear
If your return date is not certain yet, choose the latest date you might return
Conference Presentation Details
Title of Presentation*
Type of presentation*

PosterOralOther
Are you an author on the project you are presenting?*

Yes, I am the first author (or shared first author)Yes, I am an author, but not first authorNo
Did you perform this research while you were a medical student at ISMMS?*

YesNo
Research Mentor Name*

First NameLast Name
Please ask your research mentor to complete this Research Mentor Support Form. Through this form, your mentor will confirm your role in the research project you will be presenting, and endorse you presenting this research at the proposed conference.
Upload Research Mentor Support Form *

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Upload the abstract that you submitted to the conference*

Make sure the names of the authors are in the correct order
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Upload confirmation from the conference showing your abstract was acceptance*

Official letter of acceptance
Cancelof
Expenses & Funding Request
Conference Registration Fee*
If none, enter "0"
Estimated total cost of TRANSPORTATION (Flight, Train, Taxi, etc.)*
Add up all forms of transportation you expect to use. If none, enter "0"
Will you be traveling by airplane?*

YesNoNot sure yet
Estimated total cost of LODGING (Hotel, Airbnb, etc.)*
If none, enter "0"
Estimated total of OTHER expenses (meals, etc.)*
If none, enter "0"
TOTAL ESTIMATED EXPENSES
Automatically Calculated Field
Additional Funding Support
Are you receiving funding for this conference from any other sources (e.g. mentor department, conference scholarship, etc.)? Please check all that apply.*

NoYes, from Mount Sinai mentor/departmentYes, other (please describe)
Amount from Mount Sinai mentor/department*
Fund number to charge mentor/departmental support to
Please ask your mentor for this fund number, and explain to them that MedEd will process the Travel Request/Travel Voucher. If you don't have this information, please say "will provide later"
Amount from other source(s)*
Total Additional Funding Support
Automatically Calculated Field
Total Amount of Funding Requested from MSRO
Based on your responses in this form, the amount of funding needed to cover your estimated expenses is:

${totalAmount}

This is calculated as "Total Estimated Expenses - Total Additional Funding Support"

Please indicate below the amount of funding you are requesting from the MSRO.
Total Amount Needed
Automatically Calculated Field: Total Estimated Expenses - Total Additional Funding Support
Total Amount Requested*
Are you applying for Advanced Funding?*

YesNo
Advanced Funding
Requests for advanced funding have to be submitted at least 5 weeks before the conference start date.

The following expenses are eligible for advanced funding:
- Conference registration fee
- Flight
- Hotel
To be eligible for advanced funding, you are required to upload receipts of expenses that you have already incurred.

Please note that the maximum amount of advanced funding you can request is $100 less than the total amount of funding you are requesting for this conference travel. For example, if you are requesting a total of $1,000 in travel funding, you can request a maximum of $900 in advanced funding. You will receive the remaining reimbursment after the conference.
Amount of Advanced Funding Requested*
Upload Receipts (e.g. flight receipt, hotel receipt)

You can upload multiple files
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Approved Absence
Will you be missing mandatory curriculum days due to this conference?*

YesNoOther
Upload a copy of your APPROVED Absence Request

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Additional Information
Comments
Optional
By submitting this form, I attests that all the information provided is correct to the best of my knowledge.

I understand that to be reimbursed for approved expenses, I will need to submit receipt, credit card statements and boarding passes after the conference.
Should be Empty:

MSRO Conference Travel Funding Application

Student Information

Conference Details

Conference Presentation Details

Expenses & Funding Request

Additional Funding Support

Total Amount of Funding Requested from MSRO

Advanced Funding

Approved Absence

Additional Information