2009 DeLill Nasser Award Application Form

 

Applications are due by:  November 21, 2008

 

*All Fields Required

Applicant

First Name:  

Middle Initial:  

Last Name:  

Department:  

Affiliation:  

Address Line 1:  

Address Line 2:  

City:  
State/Province:    (Use 2 letters abbreviation for US States)
Zip/Postal Code:  
Country:    (Leave blank if US)
Phone Number:  

e.g.: 301-555-1515
E-mail Address:  
Position:  
Advisor/Mentor/Lab Head:  
   

Undergraduate Institution

Name:  

Year started:  

e.g.: 1999
Year ended:   e.g.: 2002
Degree Granted:  
   

Research Experience

 
If a postdoctoral associate, provide a description of your graduate research experience (limit to 700 words)
Statement of Current Research Interests and Progress
(limit to 700 words)
   

Information About Meeting/Course

Applying for funds to  
attend: 

  Meeting
 Course

Meeting/Course Title:  

Location:  

Start Date:  

e.g.: 06/12/2009

End Date:  

e.g.: 06/18/2009

Describe how the   meeting/course will   enhance your professional   development:  

   

Budget Information

Round-trip travel costs:  

$ (Please do not use commas)

Hotel/Housing:  

$ (Please do not use commas)

Tuition/Registration Fee:  

$ (Please do not use commas)

Budget Justification:
(limit to 700 words)

  
   

References

Please provide names of two references who will provide letters of recommendation. Immediately after the successful submission of your application, each person you have given as a reference will receive an e-mail requesting the submission of a letter of recommendation on your behalf, to be received by the Administrative office no later than December 8, 2008.
 

Reference 1

Name: 

Institution: 

E-mail Address: 
Phone: 
Relationship: 

Reference 2

Name: 

Institution: 

E-mail Address: 
Phone: 
Relationship: 

 

Please review this form contents for completeness and accuracy before submitting it to the GSA Administrative Office.

 

All applications will be received online. Please send any questions or concerns to:

 

Elaine Strass

Executive Director

Genetics Society of America

9650 Rockville Pike

Bethesda, MD 20814-3998

estrass@genetics-gsa.org

 

 

Applications will not be considered without letters of recommendation.
 
   
 

Genetics Society of America

9650 Rockville Pike

Bethesda, MD 20814-3998

301-634-7300 • 1-866-486-GENE

society@genetics-gsa.org