Exit SPR ECPN Travel Award 2021 APPLICANT INFORMATION Question Title * 1. PLEASE COMPLETE THE FOLLOWING REQUESTED INFORMATION: FIRST NAME LAST NAME HIGHEST DEGREE POSITION DEPARTMENT INSTITUTION ADDRESS PHONE NUMBER EMAIL Question Title * 2. Are you currently a member of the Society for Prevention Research? You MUST be a member of SPR in order to be eligible for a travel award. If you are not a member, you must apply for membership at the same time as you send in this travel award application: http://www.preventionresearch.org/membership/applications/ YES NO Question Title * 3. CURRENT PREVENTION SCIENCE MENTOR(S) MENTOR 1 MENTOR 2 MENTOR 3 Question Title * 4. Race/ethnicity American Indian, Native American Asian, Pacific islander Black, African American Spanish, HIspanic, Latino White, Caucasion, European Prefer not to specify Other (please specify) Question Title * 5. How did you hear about the ECPN travel award? SPR listserv email SPR website SPR social media (Twitter, Face Book, Instagram) Faculty advisor or mentor Colleague or fellow student Other (please specify) Question Title * 6. Are you currently a member of the Early Career Preventionist Network (ECPN) Steering Committee (informational purposes only) YES NO Question Title * 7. Will you be presenting (e.g., oral paper, poster, chair, volunteer chair, and/or discussant in a session) at the meeting? YES NO Question Title * 8. If yes, indicate your abstract ID# Question Title * 9. Are you participating in the ECPN Student Poster Contest? YES NO Question Title * 10. Are you planning to register to attend one of the pre or post conference workshops? YES NO Next >>