ASLM2016 Travel Scholarship Programme Application

The ASLM2016 Travel Scholarship Programme is a competitive programme designed to provide financial support to professionals and students who have an accepted abstract and need external funding in order to attend ASLM2016.

Please note that all award decisions are final.

Your privacy is of the utmost importance to ASLM. All information provided on this application is strictly confidential and will not be shared with anyone beyond the Travel Scholarship Programme Committee and select coordinating ASLM office staff.

Please enter your abstract submission ID*

Scholarships are awarded to attendees with accepted oral or poster abstracts.

Salutation*

Mr.
Mrs.
Ms.
Dr.
Prof.

First Name(s)*

Surname*

Organisation*

Title*

Country*

Email*

Phone*

Age*

< 25
25 - 34
35 -44
45 - 54
55 - 64
+65

Gender*

Male
Female

Level of education*

Secondary
College Graduate
Master’s Degree
Medical Degree
Doctorate

Type of Work*

What do you hope to gain by attending ASLM2016? (500 characters maximum)*

The ASLM2016 Travel Scholarship Programme is designed to fund professionals and students who need external funding to attend ASLM2016. Please write a short paragraph to demonstrate your financial need. (1,000 characters maximum)*

If awarded a Travel Scholarship, are you willing to participate in an interview about your experience at ASLM2016?*

Yes
No

Please provide any additional information the ASLM2016 Travel Scholarship Selection Committee should consider when reviewing your application. (500 characters maximum)*