Resident/Fellow Travel Request Form "*" indicates required fields First Name* Last Name* Email* Conference Name* Travel Dates* Does this request meet the 45 day requirement?*Requests must be submitted a minimum of 45 days prior to the first date of travel. If submitted in less than 45 days, an explanation for the late submission will be required. Yes No Explanation for submission*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/PresentationPlease note that files should be PDFs and not exceed 125MBMax. file size: 125 MB.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.Please upload a copy of a letter signed by your PD that states you have obtained permission from your PD to attend the conference.*Max. file size: 125 MB.* I have completed all pending administrative items including, but not limited to my New Innovations Checklist, duty hours, procedure logging or otherwise.
