Medical School Duluth Student Experience Award

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Please use this form to apply for funding for conference fees, traveling costs and educational experiences that require assistance in funding. This award may be awarded only once to you and the maximum amount awarded is $500.00. Request for funding must be for an experience that relates to our medical school mission. Please request funding at least 30 days prior to the need, special circumstances may be made under request. Funding is available for 1st and 2nd year medical students at the Duluth Campus.
In order to be reimbursed the amount of your travel expenses, you will need to provide receipts.Please submit these receipts to Dina Flaherty.

First Name *

Last Name *

Email: *

Telephone Number *

Year in Medical School *

Which conference are you going to?

Will you be presenting at this conference?

Please include abstract if available or a short description.

Have you received funding before for a student experience? Are there other funding sources available for you for this experience? *

Please be detailed

Please give us the details of why you are requesting funding. *

Amount of funds requested? *

May we publish your participation/presentation in Medical School related news? *

Yes

Submit

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