MAA Student Travel Funding Request

What to Expect

The Medical Alumni Association Board reviews completed student applications on a rolling basis. Following the Board Meeting, you will be notified whether or not you will receive funding and for what amount. Up to 8 students per year can be selected; the reward is $100 for domestic travel and $500 for international travel. The MAA only provides travel funding for coach airfare and conference fees. Currently, the MAA prioritizes international travel. If appropriate, the MAA may forward a student’s application to other departments for consideration of other travel awards.

Please Note: If selected, you will only receive funding upon the completion of your travel and if you provide the requisite documentation. The MAA does not guarantee funding for each application submitted.

Application Type (please select one of the following): Required Field

Application Type (please select one of the following): Clinical Elective Abroad
Family Medicine in Honduras
Dermatology Global Outreach Program
Conference (must be domestic and unrelated to Longitudinal Research Project)
Other

Applicant Information

First Name: Required Field

Last Name: Required Field

Graduation Year: Required Field

Primary E-mail: Required Field

Cell Phone Number:

Current Address: Required Field

Address Line 2:

Address Line 3:

City:

State:

Zip:

Country (if other than USA):

The address for mailing your check needs to match the address on your W-9 Form. If this is different than your current address, please use the fields below to share your W-9 mailing address for your check.

Address to mail check (needs to match W-9):

Address Line 2:

Address Line 3:

City:

State:

Zip:

Country (if other than USA):

Program Information

Name of Program/Elective/Conference: Required Field

Location of Program (City/Country): Required Field

Departure Date: Required Field

Open the calendar popup.

Return Date: Required Field

Open the calendar popup.

Travel Plans

Estimated Airfare:

Estimated Conference Fee (if applicable):

Other Support Received or Pending

Please list all other agencies and organizations (including from the University of Pittsburgh) from whom you have received or applied for financial support:

Have you received funding from any of these entities?

Have you received funding from any of these entities? Yes
No

Total Amount Received:

Date:

Attach Documents

Upload a list of your volunteer experience with the MAA: Required Field

Upload your completed W9 Form (please use address where you want your check to be sent): Required Field

Upload your plane ticket receipt with ticket number and payment type:

For a clinical elective: provide detailed educational objectives with a half page, single-spaced narrative explanation of why you would like to do a clinical elective abroad.

Upload clinical elective document:

For conference travel:

Provide a rational for attendance (1-2 paragraphs)
If giving an oral or poster presentation, you must submit proof that your work has been accepted at the conference and a copy of the abstract.

Upload conference rational:

Upload proof of conference acceptance:

Upload abstract of conference presentation:

For domestic conferences
Who is your faculty sponsor?

Digital Signature

Please check this box to confirm you have approval from Dr. Veldkamp for this application.

Type your full name in this box to act as your digital signature that the information you've shared and attached here is accurate.

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