American Thoracic Society



American Thoracic Society

2011 Minority Trainee Travel Award (MTTA) Program

Deadline: Friday, February 18, 2011

APPLICATION GUIDELINES

PURPOSE: The goal of the Minority Trainee Travel Award (MTTA) program of the American Thoracic Society is to increase the representation in pulmonology, critical care, sleep medicine and researchers by providing an opportunity for underrepresented minorities (e.g., African American, Hispanic, Native American, Alaskan Native and Pacific Islander), who are trainees in programs in the United States to attend the ATS International Conference (IC).

CRITERIA:

1. Applicant must be a member of an underrepresented minority, as defined by the National Institutes of Health (NIH) for the purposes of biomedical research support funding. This criterion includes individuals who self-identify as African American, Hispanic, Native American, Alaskan Native or Pacific Islander.

2. Applicant must not be the recipient of another travel award at the 2011 ATS IC.

3. Applicant must be a current trainee, at any stage of training from high school through post-doctoral fellow, at an institution in the United States.

4. Applicant must be an author on an abstract accepted for presentation at the 2011 ATS IC. The MTTA applicants may be an author of a late-breaking abstract. Late breaking abstract notification will be announced in early March so award applicants must apply with the understanding they will not be considered for the award if their abstract is denied.

5. Applicant should apply for the MTTA one-time per training period (i.e., high school student, college student, medical school, fellow, etc.)

6. Only one trainee should be nominated per mentor.

PROCEDURE:

1. Applicant must submit a Completed Application Packet by Friday, February 18, 2011.

2. Applicant may submit completed application by e-mail, fax, or paper mail to:

Email: ATS-MTTA@

Fax: (212) 315-8651

Mail:

2011 ATS MTTA

℅ Elizabeth Guzman

ATS-MTTA@

American Thoracic Society

61 Broadway, 4th Floor

New York, NY 10006-2755

Applicants will receive e-mail confirmation of receipt of applications.

3. Applicant must include the following in the Completed Application Packet:

a. Completed application form on the next page.

b. Letter of support from his/her mentor indicating:

• the contribution of the applicant to the research project

• the potential impact of the award on the applicant

• the leadership capabilities of the applicant

c. A copy of the abstract accepted for presentation at the 2011 ATS International Conference.

American Thoracic Society

2011 Minority Trainee Travel Award (MTTA) Program

DEADLINE – Friday, February 18, 2011

APPLICATION FORM

PERSONAL & CONTACT INFORMATION:

First Name/Given Name Middle Name/Middle Initial Last Name/Family Name/Surname

Gender (Please check one): Male Female Social Security #:--

Ethnicity (Please check the one corresponding to the ethnic community with which you primarily self-identify):

African American Hispanic Native American Alaskan Native Pacific Islander

Street Address line 1:

Street Address line 2:

City: State: Zip Code:

Tel: -- E-mail:

Have you been a previous recipient the MTTA award: Yes No If yes, what year:

ACADEMIC INFORMATION:

Current University/Institution:

Address line 1:

Address line 2:

City: State: Zip Code:

Current position:

EDUCATIONAL INFORMATION:

|Institution |City, State, Country |Dates of Attendance |Major – Area |Degree Earned |Total Years of |

| | | |of Study | |Training in US |

| | | | | | |

| | | | | | |

| | | | | | |

Areas of interest: PLEASE CHECK ALL THAT APPLY

Pulmonary Disease in:

Infants Children Adults Aging

Epidemiology Clinical Research Health care disparities

Molecular/cellular biology Animal models Other

Sleep Medicine in:

Infants Children Adults Aging

Epidemiology Clinical Research Health care disparities

Molecular/cellular biology Animal models Other

Critical Care in:

Infants Children Adults Aging

Epidemiology Clinical Research Health care disparities

Molecular/cellular biology Animal models Other

Are you an ATS member? Yes No What other societies do you belong to? ACCP SCCM ERS AAAAI AASM

Sponsor’s Full Name (Please Print): _________________________________ Email: ______________________ Phone:_________________________

Applicant’s Signature: ______________________________________________________ Date: ________________

APPLICANT'S SIGNATURE: By my signature, I attest that the information I have provided here is accurate.

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