SEATRAC Awardee Support Grant (ASG)

Thank you for your interest in the SEATRAC Awardee Support Grant (ASG).

Please complete the application below. Applications have rolling due dates of:

5pm on Friday, June 7th, 2024

Your application will only be reviewed by the SEATRAC Development Core Leadership.
You do NOT need to complete the entire application at one time; you may stop and return at a later time to complete it.
NOTE: In order to return to this survey, you will need the survey link provided when you chose the "SAVE & RETURN LATER" option.
If you do not keep record of the survey link, you will need to start a new application

Name

Primary Mentor

Primary Mentor Institution

* must provide value

University of Washington

Fred Hutchinson Cancer Research Center

Seattle Children's Hospital

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Description of Request

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Justification for the request

Specifically what new knowledge, skills, experience, collaborations will you acquire/foster as a result of this activity that will support your TB research.

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Dollar amount of the Request

* must provide value

Itemization of the Request

* must provide value

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Source of Matching Funds

Name

Dollar amount of matching funds

Applicants whose matching funds are sponsored by other investigators must offer proof of commitment. Use the field below to attach a copy of the sponsor's email or signed letter making the following attestation:

"I pledge $______ of matching funds for a [year] UW/SEATRAC Awardee Support Grant award for [applicant's name]. I would use [personal/project budget number] funds for the match. I understand that I am limited to sponsoring two ASG awards per calendar year."

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Name of Meeting

Location of Meeting

Dates of Meeting

Type of Presentation

Oral Presentation of abstract

Poster presentation of abstract

Other

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Attach abstract

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Attach meeting brochure or agenda

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