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  • 2019-2020 Applications – Opens December 3, 2018

    Mini-Grant Application | Mini-Grant Sponsor Form | Professional Development Grant Application | Institutional Commitment Form | Potential Reviewers Form (Optional)

    Grant Application Information

    Grant Category*
    Mini-GrantProfessional Development

    Choose Grant Type*
    Public Health MedicineBasic Science

    Amount Requested*

    Applicant Name*

    Degree*

    COMPLETE Professional Mailing Address:

    Institution Name*

    Room/Suite Number*

    Street Address*

    PO Box*

    City*

    State*

    Zip*

    Please be sure to include complete information including Division or Department:

    Telephone Number*

    Fax Number*

    Email Address*

    Title of Research Proposal*

    Co-Invesigator Name*

    Institution to Make Payable Checks to*

    Institutional Financial Officer and Address to Send Checks to:*

    For Professional Development awards only: Letters of reference will be sent from:

    Reference 1*

    Reference 2*

    Reference 3*

    The applicant attests that all information is complete and accurate, agrees to participate in the NKFMDDE Scientific Session and accepts all requirements outlined in the application materials. I understand that entering my name constitutes my signature.

    Applicant Signature*

    Sponsor, if Applicable*