University Hospitals Case Medical Center

University Hospitals Case Medical Center Association of Residency and Fellows (ARF) Sponsored Travel Award Application Guidelines

The Association of Residents and Fellows, with the support of Dr. Mike Anderson, are providing funds for a limited number of Travel Awards. The Travel Awards are used to partially defray the cost of attending a scientific meeting or symposium at which the resident or fellow is making a presentation related to their current clinical, basic or translational research. Healthcare advocacy and career development meetings are also eligible for sponsorship.

Guidelines for submitting applications are as follows: 1. Eligibility: a. Only ARF affiliated residents/ fellows are eligible to apply for the award. All ARF members, regardless of year, are eligible. b. Awards will only be given to an applicant once over the course of their time at UH (residency and/or fellowship). c. The research MUST be completed with a UH affiliated mentor. Exceptions will be made by the ARF travel award committee on a case-by- case basis. Please inquire directly for additional information on this process PRIOR to application submission. d. For primary research applications, although it is preferable that the abstract be accepted prior to the conference prior to your application for the travel award, this is not required. Funds will not be dispersed unless the abstract/submission is ultimately accepted, and the applicant attends the conference. e. If you are applying for both award types (research and advocacy/career development), separate applications are required. It is recommended, though not required, that the statement of purpose be updated to reflect the aims of each separate. 2. Award: a. Awards are used to help defray expenses related to the meeting’s registration, transportation, lodging, and meal costs. A maximum of $400 per successful application will be awarded, via I-expense reimbursement (to avoid the need to pay taxes on the amount). Please note that additional funding from other sources may be necessary to cover the total costs of attendance. b. For scientific submission, successful applicants will need to provide documentation that the applicant’s abstract has been accepted prior to award disbursement c. Verification of meeting attendance (i.e. registration confirmation, itemized receipts, etc.) will be required prior to reimbursement of funds d. Recognition of receipt of the UH ARF travel award should be included in the acknowledgments of all related poster or platform presentations. e. All successful applicants are required to compose a short post-meeting summary on their ARF-supported educational experience. 3. Selection a. The ARF Travel Award Committee will review all applications and make recommendations to ARF for approval. ARF officers render the final decision regarding all awards. b. Selections are NOT need based, and applications will be reviewed independent of personal, departmental, or other funding status. c. Criteria used to judge applications are based primarily upon the quality and scientific rigor of the application. Please write the cover letter / application portion (pages 5 or 6) towards an audience within the medical profession, but not necessarily within your particular department. d. For research awards, applications will be scored based on a combination of factors, including background of research, quality of abstract, type presentation (oral versus poster presentation), meeting, and statement of purpose. e. For advocacy and/or career development awards, the statement of purpose is the primary criteria by which applications will be scored. f. Although it is anticipated that the selection of awardees will be made within 30 days of each application deadline, additional time may be necessary depending on the number of applications. g. Although we will aim to award 8 applications per cycle, the final number of applications granted will be a function of the number of quality applications received, and current ARF funding. h. Residents and fellows whose applications were NOT selected may resubmit new applications in future award cycles, however the content of the submission may need to be changed if the conference has already passed (see below). 4. Submission a. Applications may be submitted at any of two deadlines throughout the year b. The attached applications should be TYPED (to ensure legibility), printed, and submitted with the required handwritten dates/signatures. Answers that require a choice to be circled may also be completed by hand. c. The program director and mentor portions of the award application are intended to be filled out by the respective faculty members independently. Please fill out the intended conference and conference dates, and submit to your PD and mentor for them to complete and submit. These portions may be filled out by hand. To facilitate timely submission, you may want to provide your program director and/or mentor an appropriately addressed envelope with or without postage, as necessary. d. The conference for which the award is granted must occur within one (1) calendar year of the application deadline. Applications will NOT be accepted for conferences attended before the deadline (EXCEPTION: awards for this cycle [due 5/15/15] may include any meeting scheduled after 3/1/15, to accommodate those who anticipated an earlier submission deadline). Applicants must keep these deadlines in mind when submitting applications to allow sufficient time for making arrangements to attend the meeting should their application be selected for funding. e. Resident/fellow portion of applications must be received by the noted deadlines to the following address (may be submitted in person to the GME office, or via campus mail / traditional mail; must be submitted in SINGLE 9” x 12” or greater envelope): Graduate Medical Education Office c/o ARF Travel Award Lakeside 6223, Mailstop 5049 University Hospitals, Case Medical Center 11100 Euclid Avenue Cleveland, OH 44106

Any general questions related to Resident and Fellow Travel Award should be directed to Christian Okoye at [email protected].

ARF Travel Award, Version 2.0 / PAGE #1 NOTE: The status of applications will be reviewed once per week (over the weekend, by Monday at 8:00 am), and you will be emailed once your portion and/or PD/Mentor portion of the application is complete. Any other inquiries will be answered as soon as possible, but no later than the Monday morning after which the question/request was submitted. ELECTRONIC (EMAIL) SUBMISSIONS WILL NOT BE ACCEPTED.

ARF Travel Award, Version 2.0 / PAGE #2 University Hospitals Case Medical Center Association Resident and Fellows Travel Award Application Checklist

Date of submission: ______Name: ______E-mail Address: ______Department: ______Program Director’s Name: ______Program Director’s E-mail Address (UH address preferred): ______Project Mentor’s Name: ______Project Mentor’s E-mail Address (UH address preferred): ______Start Date of Residency/Fellowship Position (Month/Year): ______Projected End Date of Residency/Fellowship Position (Month/Year): ______Application Batch: Deadline (circle one) November May Applicant is a current ARF member: (circle one) Yes No NOTE: Awards will only be granted to current ARF members. To determine if you are an active ARF member, please contact Christian ([email protected]). Applications from non-ARF members AT THE TIME OF SUBMISSION will not be reviewed. If you are submitting an ARF application and travel award application at the same time, the review of your application will be contingent upon the approval of your ARF membership application. Thus please ensure your name, last 4 of SSN, etc. on the form is accurate and legible.

Please complete all items on the checklist below and enclose a copy of all requested parts your application in a SINGLE 9” x 12” or greater envelope. Incomplete applications will not be processed, and will need to be resubmitted in their entirety to be considered further. NO APPLICATIONS WILL BE ACCEPTED AFTER THE DEADLINE – NO EXCEPTIONS. ELECTRONIC (EMAIL) SUBMISSIONS WILL NOT BE ACCEPTED – NO EXCEPTIONS. If you have any questions, comments, or concerns, please inquire early, with ample time to receive a response and submit your complete application by the stated deadline.

Submit your application by the deadline (5pm) to the following address (may be submitted in person or via campus mail / traditional postage): Graduate Medical Education Office c/o ARF Travel Award Lakeside 6223, Mailstop 5049 University Hospitals, Case Medical Center 11100 Euclid Avenue Cleveland, OH 44106

Checklist for ARF Travel Award Application (enclosed): o 1. Completed Application Checklist (Page #2) o 2. Applicant Cover Letter / Application (Page #5 or #6)

To be submitted separately: o 1. Program Director statement of endorsement (Page #3) o 2. Mentor statement of endorsement (Page #4) o NOTE: If your program director and mentor are the same person, please have him or her complete and submit both forms. ARF Travel Award, Version 2.0 / PAGE #3 PROGRAM DIRECTOR STATEMENT OF ENDORSEMENT (MUST BE SUBMITTED DIRECTLY BY PD) Resident/Fellow Applicant’s Name (please write legibly): ______Department: ______Anticipated Meeting to Attend (to be filled out by applicant): ______Anticipated Dates of Meeting (to be filled out by applicant): ______

The ARF resident/fellow travel award is an award given out to residents and/or fellows to help defray the costs of attending an academic meeting, to either present research finding and/or develop his or her career. The ARF Travel Award Committee is asking each program director to provide confidential insight into the applicants standing within the department.

[ Y / N ] The resident/fellow above is in good academic standing with our department/residency/fellowship [ Y / N ] This form was submitted in confidence. [ Y / N ] If the applicant win the award, the resident/fellow will be allowed time to attend the event as part of academic (non-vacation) time

Program Director Name: ______Program Director Signature: ______Date: ______

NOTE: THIS FORM MUST BE SUBMITTED DIRECTLY TO ARF Please submit the application directly via campus mail to the following address: Graduate Medical Education Office c/o ARF Travel Award Lakeside 6223, Mailstop 5049 University Hospitals, Case Medical Center 11100 Euclid Avenue Cleveland, OH 44106

ARF Travel Award, Version 2.0 / PAGE #4 MENTOR STATEMENT OF ENDORSEMENT (MUST BE SUBMITTED DIRECTLY BY MENTOR) Resident/Fellow Applicant’s name (please write legibly): ______Department: ______Anticipated Meeting to Attend (to be filled out by applicant): ______Anticipated Dates of Meeting (to be filled out by applicant): ______

The ARF resident/fellow travel award is an award given out to residents and/or fellows to help defray the costs of attending an academic meeting, to either present research findings and/or develop his or her career. The ARF Travel Award Committee is asking each applicant’s mentor to provide confidential insight into the applicant’s project and ability.

[ Y / N ] This form was submitted in confidence. [ Y / N ] Does the above project meet the applications objectives, as briefly stated briefly

Mentor’s Name: ______Mentor’s Signature: ______Date: ______

ARF Travel Award, Version 2.0 / PAGE #5 APPLICANT COVER LETTER / APPLICATION (RESEARCH)

PART 1: Please submit the following parts of the application as attachments. A. Statement of purpose (500 words or less): What are your academic goals, and how will attending this conference help you achieve those goals? Please reflect on both the potential presentation itself, as well the academic enrichment the conference will provide, in general. Please write this section to an audience within the medical profession, but not necessarily within your particular area of expertise or department. B. Background of research (limit to 5 citations; 500 words or less): Please outline why this research is important and/or novel, and were this research fits within the published literature. Again, please write this section to an audience within the medical profession, but not necessarily within your particular area of expertise or department. C. Abstract: Please include a copy of your abstract, including all of the authors and their affiliations. D. Proposed Budget: Please submit an itemized estimate of anticipated expenses for the meeting, including but not limited to transportation, lodging, meals, and registration. If the anticipated amount from for the ARF travel award will not cover the expenses in its entirety, please also explain what funding will be used to cover the remainder of expenses. E. Curriculum Vitae (CV) or biosketch: please including publications, awards, leadership, and/or volunteer activities

PART 2: Please fill out the following information regarding your application A. Meeting your project/abstract will be submitted to: ______B. Meeting Dates: ______C. Meeting Location: ______D. Medical Journal associated with the meeting (if applicable): ______D. Medical Organization/Association holding the meeting (if applicable): ______E. Website of call for abstracts (if not applicable, please attach meeting flyer): ______F. The abstract has been accepted for presentation [ Y / N ] G. Type of Presentation: ORAL POSTER NONE N/A UNKNOWN H. Name of Faculty mentor: ______i. UH affiliated? [ Y / N ] ii. Mentor’s Role in project (1-2 sentences): ______All information submitted by me in this application is true to the best of my knowledge and belief. I fully understand that any significant misstatements or omissions from this application constitute cause for denial. Applicant’s name: ______

ARF Travel Award, Version 2.0 / PAGE #6 Applicant’s Signature: ______

ARF Travel Award, Version 2.0 / PAGE #7 APPLICANT COVER LETTER / APPLICATION (ADVOCACY AND/OR CAREER DEVELOPMENT)

PART 1: Please submit the following parts of the application as attachments: A. Statement of purpose (up to 750 words): What are your academic goals, and how will attending this conference help you achieve those goals? Please reflect all relevant aspects of the conference, including but not limited to the conference topics, speakers, presentations, workshops, meetings, and/or any other academic-related pursuits. Please also reflect on what you anticipate on learning, and how you anticipate enriching the UH community with the knowledge you will acquire. Please write this section to an audience within the medical profession, but not necessarily within your particular area of expertise or department. B. Proposed Budget: Please submit an itemized estimate of anticipated expenses for the meeting, including but not limited to transportation, lodging, meals, and registration. If the anticipated amount from for the ARF travel award will not cover the expenses in its entirety, please also explain what funding will be used to cover the remainder of expenses. C. Curriculum Vitae (CV) or biosketch: including publications, awards, leadership, and/or volunteer activities

PART 2: Please fill out the following information regarding your application A. Meeting you plan to attend: ______B. Meeting Dates: ______C. Meeting Location: ______D. Medical Journal associated with the meeting (if applicable): ______E. Medical Organization/Association holding the meeting (if applicable): ______F. Website of meeting (if unavailable, please attach meeting flyer): ______G. Nature of conference (1-2 sentences): ______

All information submitted by me in this application is true to the best of my knowledge and belief. I fully understand that any significant misstatements or omissions from this application constitute cause for denial. Applicant’s name: ______Applicant’s Signature: ______

ARF Travel Award, Version 2.0 / PAGE #8