Application form for Student and Trainee NACCT Travel Awards

Student and Trainee NACCT Travel Award Program

The student and trainee NACCT Travel Award Program specifically supports the travel of students (graduate or medical) and trainees (residents, toxicology fellows or postdoctoral research fellows to present an abstract at the North American Congress of Clinical Toxicology (NACCT) meeting. The deadline for submission is June 1. Both the applicant and mentor must be members of AACT.

Name*
First Last
Date
Date Format: MM slash DD slash YYYY
Abstract ID #*
Institution*

Include the name and address of your affiliated institution
Email*
Phone*
Name and email address for your mentor*

Please include the name and contact information for your mentor (the person that will be submitting the letter of support)
Which travel award are you interested in applying for?*
Are you interested in practicing in the field of pediatric toxicology?*
Career Goals in terms of clinical toxicology*
Please describe your career goals as they related to the field of clinical toxicology
Career Goals in terms of pediatric clinical pharmacology and/or toxicology*
Please describe your career goals as they related to the field of pediatric clinical toxicology
Reason you are applying for this award*
Please describe why you are applying for this award
Upload required documents*
Drop files here or
Required Documents to be uploaded: 1. Student/Trainee CV 2. PDF of the abstract submitted 3. PDF of the notice of acceptance of abstract submission 4. Letter from mentor (if mentor would like to submit their letter separately, they should email it to: admin@clintox.org) stating support as well as confirming status as student/trainee. But please note that within this application. 5. include digital headshot photo
Mentor submitting a letter of support via email?*
- Yes, my mentor is submitting my LOS via email
- No, my LOS is attached to this application

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Student and Trainee NACCT Travel Award Program

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