2022 SOT Perry J. Gehring Diversity Student Travel Award Application

Details about the award are found in the SOT Perry J. Gehring Diversity Student Travel Award description. Please complete this form, filling in ALL requested information. Please upload these files: 1) SOT abstract, and 2) academic transcript(s) (including current semester enrollment). We encourage you to draft the responses in a file for your records and to copy and paste the responses here. A list of the information required is in this file.

After submission of your application, SOT staff will send a Nomination Form link to your advisor. Your advisor must complete a nomination form for your application to be considered complete. The advisor nomination form is due by October 20, 2021. A list of the information required in the advisor nomination form is in this template; please send this template to your advisor in advance.

All application materials must be completed and submitted by 11:59 PM EDT October 15, 2021.

Questions? Contact Shalimar Juan, CDI Staff Liaison

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* 1. Contact information

First Name

Middle Name

Last Name

Academic Institution

Major/Discipline

Degrees Earned

Degree In Progress

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* 2. Year attended SOT Undergraduate Diversity Program

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* 3. Current Residence

Address 1 *

Address 2

City/Town *

State *

ZIP/Postal Code *

Email Address *

Cell Phone Number *

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* 4. Alternate Email Address

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* 5. Abstract information

Title of your abstract

SOT Abstract Control/Tracking Number

Institution where research was conducted

Advisor Name

Advisor Institution

Advisor Phone

Advisor email

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* 6. Indicate current academic status

Graduate Student

Undergraduate Student

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* 7. Expected month, date, and year of degree completion (MM/DD/YYYY)

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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. Please enter below a statement about the value of your previous participation in the SOT Undergraduate Diversity and Education Program and your aspirations for a career in biomedical science (limited to 250 words or 2000 characters).

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* 12. Please upload a copy of your SOT abstract (version from the abstract submission system).

Please upload the copy of your abstract in PDF format.

PDF, DOC, DOCX file types only.

Choose File

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* 13. Upload your transcript(s) from all undergraduate institutions attended, including your current semester enrollment, together in a single file. The unofficial version is accepted. Make sure that the name of the institution is on the transcript.

Transcripts will be combined into a single PDF; please upload your transcripts in PDF format.

PDF, DOC, DOCX 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.