SOT ToxScholar Outreach Grant Application

We appreciate your application for a ToxScholar Outreach Grant, whether you plan a virtual visit at no cost or are requesting funds to support travel and event costs. This program supports SOT members who visit primarily undergraduate institutions to increase awareness of educational and career opportunities in toxicology.

If you plan to visit more than one institution on one trip, please submit a separate application for each institution.

Applications for funding are accepted at any time.

Questions? Contact Betty Eidemiller.

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* 1. ToxScholar Applicant Contact Information

First Name

Last Name

Degree(s)

Affiliation

City

State

Email address

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* 2. Indicate your SOT member status.

Graduate Student

Postdoctoral

Associate

Full

Membership pending

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* 3. Contact Information for Campus and Host

Institution to be Visited

Proposed Date of Visit

Host First Name

Host Last Name

Degree(s)

Host Position

Host Department

Address

Address1

City

State

Country

Host Email address

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* 4. Describe or classify the institution that you propose to visit (e.g., primarily undergraduate institution, 4 year liberal arts college, minority-serving institution, state institution emphasizing undergraduate teaching)

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* 5. Format for the proposed visit

On campus

Virtual

On campus visit with a virtual component

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* 6. If an additional ToxScholar will participate, please provide information for that presenter.

First Name

Last Name

Degree(s)

Affiliation

City

State

Email address

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* 7. Describe the undergraduates and others who are likely to be in the audience (e.g., biology majors, chemistry majors, premed students, general students, science faculty).

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* 8. How will you and the host recruit the audience? (check all that apply)

Rely on normal class attendance

Announcements during class

Announcements via email or electronic campus communications

Flyers

Social media

Other (please describe)

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* 9. Will your presentation be part of a course?

Yes. Provide the course title.

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* 10. Indicate any of the following which will be part of your visit (check all that apply).

Seminar series, journal club, etc.

Informal session with students (meet-and-greet, reception)

Informal meal on campus

Career session or panel

Other (please specify)

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* 11. How will the proposed visit help recruit the next generation of toxicologists?

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* 12. How will you assess the success of your visit (e.g., student attendance, contact information obtained, follow up questions, survey results, activities that resulted because of the visit, etc.)?

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* 13. If you request ToxScholar funding for a trip from one country to another, please describe how the visit aligns with, and how it will enhance, the host and host institution education program related to toxicology.

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* 14. If you have received ToxScholar funding previously, describe subsequent contact with the hosts or attendees or other outcomes.

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* 15. Funding requested from SOT

All

Partial

No funding needed

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* 16. Proposed Budget. Reimbursement follows SOT policy. Funds are designated for speaker travel and direct costs for undergraduate participation. Be specific about the funds requested as the budget will be reviewed carefully. Up to $500 can be requested for a visit in the country of residence, or up to $1250 for travel from one country to a developing country.

Travel: car (provide roundtrip miles and total cost at SOT rate)

Travel: airfare

Travel: other (label and give cost)

Speaker lodging

Speaker meals while traveling (SOT per diem $50 per day)

Event costs (e.g., flyers, room rental, food for undergraduates for the event(s), a-v (label and give cost)

Total requested from SOT

Other funding (identify source and amount)

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* 17. Upload the ToxScholar applicant's curriculum vita.

PDF, DOC, DOCX file types only.

Choose File

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* 18. Upload the letter of invitation from the campus host, which should include the purpose of the visit, the objectives to be achieved, and the particular value in having this SOT member visit the campus.

PDF, DOC, DOCX file types only.

Choose File

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* 19. Will you receive any other funding from SOT or from another source? For example, is a Regional Chapter, Special Interest Group, or your employer providing funding or assisting with arrangements? If so, provide source and amount here and upload documentation at #20.

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* 20. Upload documentation of other funding or support for this trip.

PDF, DOC, DOCX file types only.

Choose File

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* 21. Is this proposal for a ToxScholar visit...?

In the same country

International