SNMA Physician Research Initiative
Travel Fellowship
Deadline: December 20, 2013
DESCRIPTION
Funded and supported by the National Institute of Health (NIH), the SNMA Physician Research Initiative
Travel Fellowship is designed to bring premedical and medical students interested in academic medicine to
the Student National Medical Association (SNMA) Annual Medical Education Conference where they will
present past or current research as well as attend all required workshops at the SNMA Annual Medical
Education Conference (AMEC) April 16 – 20, 2014. The fellowship will provide participants with an
unparalleled opportunity to meet and network with leading physicians and scientists, faculty, residents and
each other. Travel awards will be provided to qualifying applicants in the form of AMEC registration,
transportation allowances and a possible per diem.
ELIGIBILITY

Applicant must be a member of the Student National Medical

Active (medical student) or Associate (pre-medical)

Applicants must attend accredited medical school or university

Research completed prior to or during their term in medical school
 Only applicable to current medical students
RULES FOR SUBMISSION (STRICT GUIDELINES)
All Applicants:
Completed and signed Application
Curriculum Vitae
Letter of Good Academic Standing
Transcripts

Medical Students - Official medical school transcript
 1st year students must include prior school’s transcript
 An official transcript is preferred at the time of submission. However, students may submit an
unofficial transcript with application materials by the application deadline with official
transcript due no later than January 6, 2014.

Premedical Students – Official undergraduate school transcript

Letter of intent from student describing interest in health disparities research (1-2 pages)
Abstract

One abstract per person

Must be 300 words or less

Include: Title, Introduction, Purpose or Specific Objective, Methods Used, Results, and
Conclusions
FELLOWSHIP REQUIREMENTS
Selected applicants will:
 Have received permission for excused absence from their institution to attend AMEC*
* AMEC will be held in Washington, DC April 16-20, 2014
 Present current or past research work at AMEC
 Attend all required AMEC workshops.
Address any inquiries to the Physician Research Initiative Dines Fellow/Coordinator at
pri@snma.org
SNMA Physician Research Initiative Travel Fellowship
(Email application and all required documents to pri@snma.org)
_____________________________
SNMA Membership # (write “pending” if recently paid)
_____________________
Date
__________________________/__________________/_______________________________/_________
First Name
Middle Initial
Last Name
Suffix
___________________________________________________/____________________________/______
Medical School (please no abbreviations)
City, State
Year of Exp Grad
___________________________________________________/____________________________/______
Other school currently attending (please no abbreviations)
City, State
Year of Exp Grad
___________________________________________________/____________________________/______
Undergraduate Institution (please no abbreviations)
City, State
Year of Exp Grad
______________________________________________________________________________________
Undergraduate major
Expected Degree(s) (check all that apply):
___ B.S.
___ B.A.
__ M.A.
___M.D.
___D.O.
___ J.D.
___Other(s) (please specify)______________
___Ph.D. ___M.P.H.
___M.B.A.
Abstract Title:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Please specify the category(s) that best describes your research:
□ Basic Science □ Social Science □
Clinical
□ Translational
Demographic information (optional): Age: 17-20 21-25 26-30 31-35 36-40 50+
Race (check one that most identifies you): ___Black (non-Hispanic) ___Latino/Hispanic ___Asian
___Native American ___Pacific Islander ___Caucasian ___ Other (please specify)________________
Gender: M F
Address any inquiries to the Physician Research Initiative Dines Fellow/Coordinator at
pri@snma.org
SNMA Physician Research Initiative Travel Fellowship
Contact information (Where can we best reach you?):
___________________________________________ _______________________ _______ __________
Street
City
State
Zip Code
(_______)___________________________
Home Telephone
(_______)______________________________
Mobile Telephone
________________________________________________________
E-mail Address
Assurance & Signature of Applicant
If I am awarded and do accept a fellowship, I agree to attend all required sessions and
other required activities of the SNMA Physician Research Initiative Travel Fellowship.
My signature below also means that I voluntarily agree that my demographics and other
non-identifiable information may be used for research study purposes conducted by the
SNMA.
_____________________________________________ ____________________________
Signature
Date
Deadline: December 20, 2013
Email application and all required documents to
pri@snma.org