2023 SOT Undergraduate Diversity Program Advisor Travel Award Application

Details about the award are found in the SOT Undergraduate Diversity Program Advisor Travel Award description. Please complete this form, filling in ALL requested information, including uploading of your curriculum vitae (up to 3 pages). A list of the information required is in this file.

Tip: We encourage you to draft the responses in a file for your records and to copy and paste the responses here.

Your nominator (department chair, faculty mentor, or dean) must provide a letter of reference in support of your award application, including a description of the applicant's history of mentoring students in the classroom and in research, and the applicant's commitment to diversity, equity, and inclusion in science and the university. The nominator should provide their name, address, and email in the letter, and send it directly to jenna@toxicology.org by the October 15 deadline.

All materials must be entered by 11:59 PM EDT October 17, 2022.

Questions? Email Jenna Hartsell, CDI Staff Liaison

Question Title

* 1. Name and Affiliation

First Name

Middle Name

Last Name

Highest Degree/Certifications

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* 2. Contact information

Institution *

Department *

Address Line 1 *

Address Line 2

City Town *

State *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 3. Institutional Profile: Please provide the percentage of undergraduate enrollment from these groups.

Black/African American

Hispanic/Latinx

Asian/Asian American

Native American

Native Alaskan

Pacific Islander

White

Mixed heritage

Other (please specify)

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* 4. Provide the number of advisees/mentees/research students with whom you work directly.

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* 5. How many are from groups underrepresented in the sciences as defined in the eligibility criteria?

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* 6. Are you a SOT member?

Yes

Application Pending

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* 7. Have you received an advisor travel award for a previous SOT Annual Meeting?

Yes, in year

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* 8. Ethnic/Racial Background (check all that apply) - For program demographics

Black/African American

Hispanic/Latinx

Asian/Asian American

Native American, including Alaskan and Pacific Islander

White

Other (please specify)

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* 9. Gender

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* 10. Preferred Pronouns to Use

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* 11. Support Requested: (choose one; this choice is not a factor in evaluating your application)

You or your institution will assume your travel expenses (i.e., plane, train, car) if SOT provides lodging and registration.

You are requesting SOT support for travel, lodging, and registration expenses.

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* 12. Please enter below a statement of no more than 300 words (or 2,400 characters) describing your activities encouraging students from diverse backgrounds, especially those from racial/ethnic groups underrepresented in the sciences, to pursue science careers.

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* 13. Upload your curriculum vitae (up to 3 pages)

Please upload this file labeled as [YourLastName]_CV

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

In submitting this application I consent to the inclusion of my information in aggregate data used by SOT, in compliance with the SOT privacy policy, and agree that SOT may send me information of potential interest. Other than access by reviewers during the selection, the permission for SOT to contact, and distribution of names and emails to academic programs if permission is granted, SOT will not release individual information.