_AM - Travel Awards

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Please select the travel award(s) you are applying for:

Developing Nation Travel Award

Early Career Travel Award

Nurse or Allied Health Professional Travel Award

IASLC International Mentorship Program

Applicant Information

Title

First Name

Last Name

Email Address

Institution

Country

Mandatory Supporting Materials

Please name each of the mandatory supporting material files as per examples below. Please note only PDF files should be uploaded.

• John Smith - CV
• John Smith - Research

Abstract ID

Curriculum Vitae

Description of Your Interest and Current Research in Lung Cancer (1-5 pages)

Mandatory Supporting Materials

Please name each of the mandatory supporting material files as per examples below. Please note only PDF files should be uploaded.

• John Smith - CV
• John Smith - Statement by an Active IASLC Member
• John Smith - Proof of Date of Training Completion
• John Smith - Proof of Date of Initial Faculty Appointment

Abstract ID

Curriculum Vitae

Active IASLC Member's Full Name

Active IASLC Member's Email Address

Statement by an Active IASLC Member of the Candidate's Role in the Research and Supporting the Application

Verification of Current Trainee Status and/or Proof of Date of Training Completion

Verification of Current Trainee Status and/or Proof of Date of Training Completion Document

If Applicable, Proof of Date of Initial Faculty Appointment

If Applicable, Proof of Date of Initial Faculty Appointment Document (EC)

• Applicant must be a submitter and presenter of an abstract accepted for presentation
• Applicant must certify/agree that they do not already have funding from another source (employer, etc.)
• Applicant must be in a profession that is Nursing or Allied Health related
• Applicant must be either an early career professional * and/or are from a Developing Country
• Applicant must submit a full Curriculum Vitae
• If you are applying as an early career professional*, you must submit proof of date of completion of training or of initial faculty appointment

*Early Career Professional Definition: The applicant must be within 3 years of initial faculty appointment or within 3 years of completing training in a nursing or allied health professional setting (For Example, the candidate must be appointed to faculty or have accepted placement no later than September 30, 2016).

Additional Applicant Information

Profession

If you selected 'Other', please specify your profession

I agree that I have not received funding from another source to attend WCLC 2019

Mandatory Supporting Materials

Please name each of the mandatory supporting material files as per examples below. Please note only PDF files should be uploaded.

• John Smith - CV
• John Smith - Proof of Date of Training Completion OR Proof of Date of Initial Faculty Appointment

Abstract ID

Curriculum Vitae

Proof of Date of Training Completion

Proof of Date of Training Completion Supporting Document

Proof of Date of Initial Faculty Appointment

Proof of Date of Initial Faculty Appointment Supporting Document

Additional Applicant Information

Position Title

Abstract ID

Abstract Title

Abstract Authors (first & last name)

Degree

If you selected 'Other', please specify your degree

Gender

Please select one that best describes your current primary position

What is your primary specialty?

If you selected 'Other', please specify your primary specialty

Have you attended other WCLC conferences in the past?

How did you hear about this program?

If you selected 'Other', please let us know how you heard about this program

Mandatory Supporting Materials

Please name each of the mandatory supporting material files as per examples below. Please note only PDF files should be uploaded.

• John Smith - Personal Photograph
• John Smith - CV
• John Smith - Letter of Intent
• John Smith - Research Support
• John Smith - First Letter of Recommendation
• John Smith - Second Letter of Recommendation

Personal Photograph (max file size: 1MB)

Curriculum Vitae

Letter of Intent (please explain why you would like to receive this award and how winning would contribute to your scientific and/or clinical interests)

Research Support (list selected ongoing, completed during the last three years and pending public and private supported research projects. Begin with the most relevant projects to the research proposed in this application and briefly indicate the overall goals of the projects and your role in the research project.)

First Letter of Recommendation (it is preferred that at least one letter is from an IASLC member)

Second Letter of Recommendation (it is preferred that at least one letter is from an IASLC member)

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