Resident/Fellow Travel Request Form First Name* Last Name* UFID* Email* Conference Name* Travel Dates* Expected BudgetRegistration Fee Hotel Flight Other (Include the expense type and approximate amount. Note: Food expenses are not covered.)If the conference offers travel assistance/scholarships, did you apply?* No, assistance is not available Yes, I applied, but funding was denied Yes, I applied and was awarded: Amount awarded and items covered Note: If external travel assistance/scholarships are available, you must apply in order to qualify for internal funding. Please upload a copy of your Poster/Presentation Acceptance Notification*Max. file size: 125 MB.Please upload a copy of your Conference Agenda*Max. file size: 125 MB.* I have obtained permission from my Program Director to attend the conference * I have completed all pending administrative items including, but not limited to my New Innovations Checklist, duty hours, procedure logging or otherwise.