SPR Minority Travel Award 2022 APPLICANT INFORMATION Question Title * 1. PLEASE COMPLETE THE FOLLOWING REQUESTED INFORMATION: (Required.) FIRST NAME LAST NAME HIGHEST DEGREE POSITION DEPARTMENT INSTITUTION ADDRESS PHONE NUMBER FAX NUMBER EMAIL Question Title * 2. Race/Ethnicity (Required.) American Indian, Native American Asian, Pacific Islander Black, African American Spanish, Hispanic, Latino Other If Other (please specify) Question Title * 3. CURRENT PREVENTION SCIENCE MENTOR(S) MENTOR 1 MENTOR 2 MENTOR 3 Question Title * 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 Question Title * 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 Question Title * 6. If yes, indicate your abstract ID# Question Title * 7. Are you planning to register to attend one of the preconference workshops? (Required.) YES NO Next >>