American Thoracic Society
2011 Resident Travel Award (RTA) Program
DEADLINE – Friday, February 18, 2011
INSTRUCTIONS
PURPOSE:
The American Thoracic Society’s Resident Travel Award (RTA) program is for internal medicine and pediatric residents. The
goal of the program is to increase the physician workforce numbers in clinical and research careers in pulmonary and/or
critical care medicine by providing an opportunity for residents to attend the ATS International Conference. It is believed that
exposure to the excitement of the scientific, translational and clinical information presented at the conference will provide a
compelling series of reasons for residents to enter one of these.
ELIGIBILITY:
An applicant for an ATS Resident Travel Award MUST:
 Be an internal medicine or pediatric resident who has not been accepted by an adult or pediatric pulmonary and/or
critical care, or sleep fellowship program
 Declare an interest in a career in adult or pediatric pulmonary, critical care or sleep medicine
 Able to attend the ATS International Conference to receive the award where he/she will be identified with a ribbon
recognizing the honor
 Applicant must not be a recipient of the RTA in 2010
Optional: Additional consideration will be given to applicants who are authors on abstracts accepted for presentation or
are presenters at sessions programmed for the ATS International Conference.
PROCEDURE:
1. Applicant may submit completed Application Packet to:
Elizabeth Guzman
Coordinator, Education Programs
Email: ATS-RTA@thoracic.org.
Fax: 212-315-8651
Phone: 212-315-8627
Note: each application successfully submitted will receive an email
confirmation of receipt.
2. An Application Packet will consist of:
 An Application Form (see next page) which includes an indication of approval of the adult or pediatric residency
director for the resident to attend the ATS International Conference in Denver, Colorado.
 A one-page personal statement from the adult or pediatric resident applicant indicating why he/she is interested in:
 entering a career in adult or pediatric pulmonary and/or critical care medicine
 in attending the ATS International Conference

A one-page letter of support from a sponsoring ATS member indicating whether he/she is willing to serve as a
mentor/guide to the applicant at the International Conference. The sponsoring ATS member is asked to identify
another ATS member who can serve this function, if he/she cannot fulfill this responsibility.
3. Applicant must submit a completed Application Packet to ATS by Friday, February 18, 2011.
American Thoracic Society
2011 Resident Travel Award (RTA) Program
DEADLINE – Friday, February 18, 2011
APPLICATION FORM
APPLICANT INFORMATION:
Name (First, Middle, Last, and Credentials):
Gender (Please check one):
Male
________________________________________________________
Female
Institution Name (if a work address):
Social Security #:
_________________________
____________________________________________________
Street Address line 1:
__________________________________________________________________________
Street Address line 2:
__________________________________________________________________________
City:
_______________________
Tel:
_______________________
Are you an ATS member?:
State:
____
E-mail:
Zip Code:
_______________________
_____________________________________________
Yes. My ATS Membership ID is
________
No, I am not an ATS member.
Are you an author on an abstract accepted for presentation at the ATS International Conference?
Are you a presenter in a programmed session at the ATS International Conference?
Yes
Yes
No
No
RESIDENCY PROGRAM INFORMATION:
Program Type:
Internal Medicine
I am currently in my
Pediatric
I am currently a Resident in this program:
Yes
No
__ Resident Year
Institution Name (if a work address):
____________________________________________________
Street Address line 1:
__________________________________________________________________________
Street Address line 2:
__________________________________________________________________________
City:
_______________________
State:
_______
Zip Code:
_______________________
RESIDENCY DIRECTOR INFORMATION:
Name (First, Middle, Last, and Credentials):
Tel:
_______________________
Residency Director’s Signature:
________________________________________________________
E-mail:
_____________________________________________
__________________________________________________________________
By my electronic or physical signature, I attest that the information provided here is accurate, and that if selected for an ATS Resident Travel Award, the applicant named above is approved to travel to
the ATS International Conference.
SPONSORING ATS MEMBER INFORMATION:
Name (First, Middle, Last, and Credentials):
Tel:
_______________________
________________________________________________________
E-mail:
_____________________________________________
APPLICANT’S SIGNATURE AND ATTESTATION:
Applicant’s Signature:
________________________________________
Date:
___________________
APPLICANT'S SIGNATURE: By my signature, I attest that the information I have provided here is accurate.