Innovation Summit Travel Stipend Request Form

2025 TANGO2 Innovation Summit

Travel Stipend Request Form
The TANGO2 Research Foundation is offering travel stipends of up to $400 USD to help offset travel-related expenses for attendees participating in the TANGO2 Innovation Summit. Awards will be based on need and availability of funds. Please complete all sections of this form for consideration.

Event Date: December 15, 2025

Location: Houston Marriott Medical Center/Museum District 6580 Fannin Street, Houston, Texas 77030 (Driveway Entrance on 1730 Dryden Road)

Stipend Amount: Up to $400 USD (to offset travel-related expenses)

Travel Stipend Reimbursement Form Deadline: December 31, 2025 5pm (EST)

*If you are no longer able to attend the 2025 TANGO2 Innovation Summit, you will forfeit your opportunity to request a travel stipend.

*Upon approval of the travel stipend reimbursement request form and supporting travel documentation, travel stipends will be issued directly to recipients within 30 days following the event.

Applicant Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Country CodeArea CodePhone Number
Address (Please check your response for accuracy. Reimbursement checks will be mailed to the address provided here).*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Grand Total of Travel Cost (in USD)*
Note: Applicants will need to use the most economical travel options (economy flights, regular Uber/Lyft, economy train), and mileage will be reimbursed at the GSA rate found on gsa.gov.
Method of Travel (Check all options that apply)*

AirfareTrain/BusPersonal Vehicle (Mileage reimbursement at standard IRS rate)Ride-share (i.e. Uber/Lyft)/TaxiOther
Please provide the amount (USD) of your Airfare*
Note: Applicants will need to use the most economical travel options (economy flights, regular Uber/Lyft, economy train), and mileage will be reimbursed at the GSA rate found on gsa.gov
Please provide the amount (USD) of your Train/Bus fare*
Note: Applicants will need to use the most economical travel options (economy flights, regular Uber/Lyft, economy train), and mileage will be reimbursed at the GSA rate found on gsa.gov
Please provide the amount (USD) of your Personal Vehicle use milage cost (at the standard IRS rate)*
Note: Applicants will need to use the most economical travel options (economy flights, regular Uber/Lyft, economy train), and mileage will be reimbursed at the GSA rate found on gsa.gov
Please provide the amount (USD) of your Ride-share cost *
Note: Applicants will need to use the most economical travel options (economy flights, regular Uber/Lyft, economy train), and mileage will be reimbursed at the GSA rate found on gsa.gov
Please provide the amount (USD) of your Other method of travel *
Note: Applicants will need to use the most economical travel options (economy flights, regular Uber/Lyft, economy train), and mileage will be reimbursed at the GSA rate found on gsa.gov
Please upload all receipts for travel related expenses as one pdf file*

Cancelof
Did limited flight availability require you to extend your hotel stay and check out on 12/16/2025 instead of 12/15/2025?*

YesNo
Total Amount Requested (in USD)*
Applicants can request up to $400 (USD) Funding cannot be used for: Personal travel unrelated to the 2025 Innovation Summit, Travel companions, Cell phone charges, House, pet/animal, or child sitters, Laundry or clothing cleaning services, Souvenirs, Hotel room purchases, not complimentary provided Food & beverages, Car rental, Passport/visa renewal or new applications, Chauffeured limousine services, Change fees associated with flight, train, etc., baggage fees, travel upgrades (flight, train, etc), gas/fuel, internet/wifi charges, TSA pre-check and Hotel/vacation/rental properties.
T2RF Travel Stipend Agreement

By the checking the box below I understand;
- Travel stipend funds are to be used exclusively for travel expenses to and from the TANGO2 Innovation Summit.
- Reciepts for travel expenses must be submitted with this form within 15 days after the event to receive reimbursement.
- Trave stipend amounts may not fully cover all travel related expenses.
- I am responsible for making my own travel arrangements.
I understand, acknowledge and agree to the conditions outlined above in the T2RF Travel Stipend Agreement*

Yes
Applicant Signature*

Clear
Date of Signing*

MonthDayYear
Date
Should be Empty:

2025 TANGO2 Innovation Summit