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American Indian Health Research Conference

Student Travel Award Application

Due: October 6, 2009

Student travel scholarships will cover the cost of the registration fee, hotel room, meals not included with the conference, and mileage. Students are encouraged to share hotel rooms and carpool. Maximum amount of travel coverage will be based on a case by case basis for students outside of ND, MN, SD, and MT.

Please make hotel reservations at the Canad Inns, 1000 South 42nd Street, Grand Forks (connected to the Alerus Center) by September 22, 2009. To make your reservation, contact 701-772-8404 and ask for the American Indian Health Research Conference room block.

You can also download the printable version here.

Date
Student Name
Address
City/State/Zip
Phone
Email
School Attending

Has your poster/presentation been accepted for the American Indian Health Research Conference? (check one)
Yes
No
Not Yet
I am planning to attend the conference as an observer.

What is the title of your poster/presentation, if applicable?

What travel expenses would you like assistance with: (Check all that apply.)
Registration fee
Gas
Hotel
Food
Other, please specify
   
What are your estimated travel expenses?
$

Are you planning on traveling with other students?
Yes
No
Other, please list
If yes, provide student names