Travel Award Form

Your Name:

Your pronouns:

Your E-Mail Address:

Department

PI/Mentor:

Current position:

Meeting Name:

Meeting Location:

Meeting Dates: mm/dd/yyyy-mm/dd/yyyy

Requested Travel Award Amount (Up to $500): The following link will help estimate travel cost https://www.gsa.gov/travel/plan-book/per-diem-rates

Estimated Airfare:

Estimated Hotel:

Estimated Registration:

Estimated Ground Transportation:

Estimated Meals:

What other Travel Awards have you applied for?:

How much was the requested award amount(s)?:

Have any been awarded?:

If yes, how much has been awarded?:

Please attach abstract must list title, all authors and affiliations, text of abstract and grant acknowledgments.

Please attach abstract acceptance form

Center for Integrative Environmental Health Sciences

500 South Preston Street,

Suite 1319

Louisville, Kentucky 40202

Office Hours

M-F 8:00am to 4:30 pm

No holiday hours

Phone

tel (502) 852-9316

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