FACULTY EDUCATIONAL ENRICHMENT AWARD

Instructions

All fields with an asterisk (*) at the top left corner are required fields.

Submission deadline is at least 2 months prior to your meeting

Grant award is limited to meetings/activities in which direct association with

education can be demonstrated

First Name: *

Last Name: *

Credentials (MD, PhD, etc): *

Position Title: *

e-mail *

Phone: *

Department or Program: *

Date of Conference: *

Name of Conference: *

Link to Conference Website (paste url): *

Education Scholarhip Opportunities Provided

Provide a clear description of the components of educational scholarship provided in the meeting/activity for which you are applying for funding. If only a portion of the meeting you are attending contains an education venue, clearly describe this portion, and how you will participate. Please provide a description as to your assessment of the level of educational scholarship that is provided within the meeting/activity you wish to attend. For example, is this meeting/activity primarily focused around education/teaching topics, clinical topics, and/or research topics? If the meeting is primarily/typically focused around clinical and/or research topics, please identify how you will participate the educational/teaching aspects of the meeting, Specifically identify:

1) educational/teaching symposia or sessions you will attend,

2) if presenting an educational/teaching-associated abstract, identify the symposium or session in which you will present your work and include a copy of the abstract as an attachment to your submission, and,

3) how your work to be presented, is directly associated with your development and scholarship as an educator.

Education/Teaching Career Development and University Teaching Mission

Please provide a description of how attendance of this meeting/activity will enhance your educational development and further the teaching mission of the University of Texas Medical Branch. Within your answer, please be specific with regard to the immediate and longer-term impact that you believe the meeting will have on the development of your career as an educator at UTMB.

Budget for Meeting Expenses

Budget for Meeting Expenses *

	Amount
Registration	Amount
Airfare	Amount
Hotel Accommodations	Amount
Total Costs for entire meeting	Amount
Total Amount Requested from the Academy	Amount

If funding is not received from the AMT, I (will/will not) be able to attend this event. *

will

will not

Please upload your Biosketch here *

Please upload a letter of support from your Departmental Chairperson acknowledging the travel request and detailing: 1) the specific impact that attendance of this meeting/activity will have on your career as a UTMB educator and faculty member, 2) there are no other funding sources available for you to utilize, i.e., that you either do or do not have additional non-AMT funds available for support of your travel to this meeting, and 3) that he/she supports administrative leave for this travel. *

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