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SPR Minority Travel Award 2024
APPLICANT INFORMATION
*
1.
PLEASE COMPLETE THE FOLLOWING REQUESTED INFORMATION:
(Required.)
FIRST NAME
LAST NAME
HIGHEST DEGREE
POSITION
DEPARTMENT
INSTITUTION
ADDRESS
PHONE NUMBER
EMAIL
*
2.
Race/Ethnicity
(Required.)
American Indian, Native American
Asian, Pacific Islander
Black, African American
Spanish, Hispanic, Latino
Other
If Other (please specify)
3.
CURRENT PREVENTION SCIENCE MENTOR(S)
MENTOR 1
MENTOR 2
MENTOR 3
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4.
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/
(Required.)
YES
NO
*
5.
Will you be presenting (e.g., oral paper, poster, chair, volunteer chair, and/or discussant in a session) at the meeting?
(Required.)
YES
NO
6.
If yes, indicate your abstract ID#
*
7.
Are you planning to register to attend one of the preconference workshops?
(Required.)
YES
NO
