Conference Attendance Funding Approval Form

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This form is to be submitted concurrently with your abstract submission. If you not planning to submit an abstract, this form is still to be submitted by the date of the conference’s abstract deadline.

Resident Name *

Date you are submitting this form (SHOULD BE NO LATER THAN THE ABSTRACT SUBMISSION DEADLINE) *

YYYY

What is the title of your abstract? *

Who is the faculty person associated with this abstract? *

Date you submitted the abstract? *

YYYY

Conference Name *

Conference Dates (MM/DD/YY, dates you are requesting to be away...) *

Will you submit these conference dates on the "Call Request Form"? Note: Even if you're unsure when you will attend the conference, submit the call requests now so we can have it in the system. We can always make changes at a later date. *

Yes

Did you obtain approval from the director of the rotation which you will be on at the time of the conference? *

Yes

Not sure which rotation I will be on at the time as schedules have not yet been released

If you know which rotation you will be on at the time of the conference, please get approval from your rotation director before submitting this form.

Other:

Is this your first conference for the academic year? *

Yes

If you answered NO and desire departmental funding to attend this conference, please describe below why you should be exempted from the one conference per year guideline. (PLEASE NOTE, RESIDENTS ARE TYPICALLY ONLY GIVEN FUNDING TO ATTEND ONE CONFERENCE PER ACADEMIC YEAR).

For Administrative Purposes Only: Your request has been approved

Yes

With Revision

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Please Paste a Copy of Your Abstract Here.

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