Women in Endocrinology Sponsored Early Career Forum Travel Award
(2 awards available for 2014)
Instructions.
Awardees shall receive: a $400 travel award, registration to the Endocrine Society meeting
and a ticket to the Women in Endocrinology dinner.
Eligibility: Applicants must meet the following requirements:
 Preference will be given to applicants, trainees and sponsors who are current members of
Women in Endocrinology. Each sponsor may nominate only one candidate per year.
 Applicants must be Endocrine Society members in good standing. If you are not yet a member,
be sure to apply or renew your membership before the nomination deadline.
 Applicants must be currently enrolled as one of the following:
 A fellow in an adult or pediatric endocrine training program.
 A medical student in an accredited MD granting program.
 A graduate student in a PhD granting program.
 A basic-science post-doctoral fellow.
 ENDO travel-grant recipients or Women in Endocrinology sponsored awardees from the
previous years are ineligible.
 Awards are given to both women and men.
What to Send: A single PDF of the following material:
The following items must be received to constitute a complete application:
Completed application form – "WE sponsored Early Career Forum Award Face Page".
Program Director Signature Page, signed and dated.
One-paragraph letter of recommendation from Program Director or Research Mentor
Please be sure to include your first and last name on all application materials submitted.
Extended Deadline: February 14th.
Where to Submit: All materials should be sent by e-mail to Jen Condon
condonj@pitt.edu
Application for WE Sponsored Early Career Forum Travel Award
PRINT OR TYPE:
Name:
___________________________________________________________________________________________
Highest Degree:
Date Earned:
Current Department or Division
Current Institution:
Work Address:
_______________________________________________________
______________________________________________
__________________________________________________________________________
_______________________________________________________________________
______________________________________________________________________________________
Home Address:
______________________________________________________________________________
_______________________________________________________________________________________________
Phone:
FAX:
Email:
__________________________________________________________
Present Position:
Date Appointed:
_________
If in-training (grad student, post-doc., clinical fellow), name of mentor:
_______________________________________________________________________________________________
Member of WE?
You (X one)
YES
NO
Your Mentor (X one)
YES
NO
Member of The Endocrine Society?
(X one)
YES
NO
Have you attended other meetings of the Endocrine Society?
(X one)
YES
NO
Year(s):
____________________________________
Have you or one of your fellows received a WE travel award previously?
(X one)
YES
NO
Year(s):
____________________________________
List other funds available to support your travel to the Endocrine Meetings
_______________________________________________________________________________________________
US Citizen (X one)
YES
Description of Research Area:
NO
Social Security number:
____________________
_______________________________________________________________
_______________________________________________________________________________________________