WCC/Eli Lilly Travel Award

APPLICANT INFORMATION

All applications must be submitted by June 1, 2024 at 11:30 p.m. EDT

First Name *

MI

Last Name *

Notification Mailing Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Where did you learn about this program? *

Demographic Information

We ask you to provide this voluntary information below because the American Chemical Society is eager to support programs that benefit underrepresented groups in the chemical sciences, and your responses are helpful to these efforts and to all facets of our services to all members. Individual responses are held in strictest confidence and have no bearing on consideration.

Date of Birth (mm/dd/yyyy)

Only U.S. citizens and permanent residents are eligible for this award.

Citizenship Status

US Citizen

US Permanent Resident

Country of Birth

Racial-Ethnic Origin

ACADEMIC INFORMATION

College/University *

Major *

Academic Advisor (First, MI, Last) *

Current Status *

Undergraduate Student

Graduate Student

Years completed *

* If Graduate Student, what level?

M.S./M.A.

Ph.D.

Postdoctoral Fellow

Date you started your program (mm/yyyy) *

Please list all meetings at which you have given an oral or poster presentation *

MEETING INFORMATION

Attendance for the ACS Fall Meeting is required for recipients of this award cycle. Awardees will present their research as a part of the Women Chemists Committee symposia at one of the meetings applied for.

Meeting which you plan to attend (no abbreviations or acronyms please) - ACS Spring or Fall Meeting *

Meeting Location *

* Meeting Date

MEETING EXPENSES

Transportation Cost *

Mode of Transportation *

Meeting Registration Cost *

Hotel Cost *

Total estimated costs for attending the meeting *

FUNDING FROM OTHER SOURCES

Amount from Advisor *

Amount from other source (please specify) *

Total estimated funding available from other sources. *

APPLICATION MATERIALS -- In PDF format please and NO embedded documents.

Please provide your Resume / C.V. (PDF please) *

Please provide a letter detailing the reasons why you want this award (both scientific and financial), and specifying whether you have made a previous presentation at a national or major meeting. (PDF only) *

Please provide a copy of your abstract submission which should include your abstract title, author(s), and text. (PDF only) *

Please provide a letter from your advisor confirming your participation in the meeting at which you will be making your presentation, commenting on your technical ability and potential, and listing of any other travel support that would be available from the department or research grants. (PDF only). If your advisor would like to send it in themselves, please have your academic/research advisor complete the form at https://fs7.formsite.com/acsdiversity/form530198771/index. In this form the advisor will be required to upload a letter of recommendation. This form must be submitted by the application deadline.

Have you provided your advisor letter or will they upload it? *

Yes, I have attached it.

No, they will be sending it.

APPLICANT CERTIFICATION

I certify that the information provided in this application is accurate and that I meet the criteria as stated in the award qualifications to the best of my knowledge. *

Confirm

Initials *

Date *

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