SPR Minority Travel Award 2023
Applicants from underrepresented backgrounds will be given priority consideration (see https://diversity.nih.gov/about-us/population-underrepresented).

APPLICANT INFORMATION

Question Title

* 1. PLEASE COMPLETE THE FOLLOWING REQUESTED INFORMATION:

FIRST NAME

LAST NAME

HIGHEST DEGREE

POSITION

DEPARTMENT

INSTITUTION

ADDRESS

PHONE NUMBER

FAX NUMBER

EMAIL

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* 2. Race/Ethnicity

American Indian, Native American

Asian, Pacific Islander

Black, African American

Spanish, Hispanic, Latino

Other

If Other (please specify)

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* 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/

YES

NO

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* 5. Will you be presenting (e.g., oral paper, poster, chair, volunteer chair, and/or discussant in a session) at the meeting?

YES

NO

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* 6. If yes, indicate your abstract ID#

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* 7. Are you planning to register to attend one of the preconference workshops?

YES

NO