Student Travel Applications Form - College of Medicine

Name(s)*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email*
Check One:*
- Class of 2026 (Incoming Freshman 2022)
- Class of 2025 (Current M1)
- Class of 2024 (Current M2)
- Class of 2023 (Current M3)
- Class of 2022 (Current M4)
If Organization, list all students funds will assist:
1.
2.
3.
4.
5.
6.
7.
Name of Event:*
Location of Event:*
Event Date(s)*
Total Cost for Event:*
Student/Organization Contribution:*
Amount requested from UAMS Parents Club:*
Describe cost included in "Total Cost" (Conference fees, Travel, Food, Lodging, etc.):*
Attendee's Participation at Event (i.e. Attending, Presenting a Paper/Poster, Speaking):*
Describe the Expected Positive Outcome of the Event for UAMS and/or UAMS Students:*
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Contact UAMS Parents Club