2023 Travel Scholarship Application Form 2023 PeDRA Annual Conference Travel Scholarship Application Form Please complete the following application to be considered for a 2023 PeDRA Annual Conference travel scholarship. Send an email to conference@pedraresearch.org or call 971-369-0386 if you have questions along the way or encounter any trouble with the form.PeDRA is proud to offer Travel Scholarships to help offset the cost of travel for Trainee Members, Community Members, and Active or Affiliate Members within two years of completing training. Scholarships are available to eligible applicants from all backgrounds including, but not limited to, individuals from communities that are underrepresented in medicine (URiM). Scholarships will be awarded following an application and competitive review process, depending on the availability of funds and the merit of applications received. To be considered, you must be registered for the 2023 PeDRA Annual Conference and submit an application before 5 PM PT on September 14, 2023. The 2023 PeDRA Annual Conference Travel Scholarship includes the following:PeDRA will waive* the registration fee for scholarship recipients PeDRA will award up to $595 to cover travel expenses to attend the 2023 Annual Conference for those traveling to Atlanta or up to $100 to cover expenses for local attendees. To be eligible for the 2023 PeDRA Annual Conference Travel Scholarship:All applicants must submit their application before 5 PM PT on September 14, 2023.All recipients must be a PeDRA Member.**All applicants must also be registered for the Conference to be eligible for a scholarship.All non-local recipients must also stay at the conference headquarters - The Westin Buckhead Atlanta. If you are interested in sharing a room, we recommend that you check the Conference App message board for attendees interested in sharing a room.Trainee Members, who are medical students, must also be accepted to participate in the NextGen Research Forum with a short presentation to be eligible to receive a Travel Scholarship. This stipulation does not apply to any other member category. *PeDRA will refund all scholarship recipient's conference registration fees upon acceptance of the award. If you are not awarded a scholarship, PeDRA will give you the option to cancel registration by October 1, 2023, without Penalty.**If you are interested in a scholarship but not a PeDRA member, you can apply to become a member here. You are free to register under your anticipated category while your membership application is being reviewed. Applicant Information Please select the description below that best describes you: PeDRA Trainee MemberPeDRA Active or Affiliate Member < 2 years out of trainingPatient, Parent, Advocate, or PeDRA Community Member*Trainee Members, who are medical students, must also be accepted to participate in the NextGen Research Forum with a short presentation to be eligible to receive a Travel Scholarship. This stipulation does not apply to any other member category. First Name Last Name Credentials if applicable: Primary Affiliation Email Address City StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau State/Province ProvincePlease select... Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon CountryPlease select... Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos ( Keeling ) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte d ' Ivoire Croatia ( Hrvatska ) Cuba Cyprus Czech Republic Congo ( DRC ) Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands ( Islas Malvinas ) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Samoa San Marino São Tomé and Prìncipe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Virgin Islands ( British ) Virgin Islands Wallis and Futuna Yemen Zambia Zimbabwe Postal Code Please select what most accurately describes your current position:New Clinician and/or Investigator (within 2 years of finishing training)Clinical FellowResidentResearch FellowMedical or Graduate StudentOther Other - please describe Please tell us more about yourself. Select all that apply: I am the parent or guardian of a pediatric patient. I am a representative from a patient advocacy organization.I am a patient (over the age of 18). Will your child (or children) also be joining us in person for the conference? Yes*No*Please also complete the Mini Camp Wonder at PeDRA application HERE. Advocate positionScientific and/or Medical Leadership (CSO/CMO, Medical Director, or similar)Advocacy or Professional Relations LeadershipScientific and/or Medical Affairs StaffAdvocacy or Professional Relations StaffPatient or CaregiverOther Please explain your selection of "other" here: Have you attended a PeDRA Annual Conference in the past?Yes, I have attended both in-person and virtual PeDRA Annual Conferences in the pastYes, I have attended in-person PeDRA Annual Conference(s) onlyYes, I have attended virtual PeDRA Annual Conference(s) onlyNo, 2023 will be my first PeDRA Annual Conference Demographics PeDRA is committed to supporting equity, diversity, and inclusion across all facets of its organization, programs, committees, leadership, and research studies. We ask for demographic information from PeDRA Annual Conference attendees to ensure we have accurate and complete data to help achieve this goal. All data collected is kept safely and only de-identified aggregate data may be shared for strategic purposes. Please specify your gender:FemaleMaleNon-binaryI do not wish to provide this information. With what race(s) do you self-identify? Please select all that apply. American Indian or Alaska Native Asian Black or African American Hispanic or Latinx Middle Eastern or Northern African Native Hawaiian or other Pacific Islander White Other - write in I do not wish to provide this information. Other - write in race: Medical or graduate students, and research fellows must submit an application to present at the NextGen Research Forum taking place on the evening of Thursday, November 9, and the morning of Friday, November 10 to be eligible for a travel scholarship. This forum is designed to support students and recent graduates and will include networking time, career guidance, and the opportunity to present to a small group. Please indicate if you have already applied or intend to apply to present at the NextGen Research Forum. YesNoPlease note that everyone interested in joining the NextGen Research Forum must also separately apply using the NextGen Research Forum application by September 14. 2023 PeDRA Annual Conference Travel Scholarship Application Please provide a statement of interest describing your reason for wanting to attend the 2023 PeDRA Annual Conference (250-word maximum). Please provide a statement of interest describing how a 2023 Travel Scholarship will help you attend (250-word maximum). Are you expecting to be an author or collaborator on any research being presented or discussed at the conference? Please select all that apply:NextGen Research ForumBreakout Session Project DiscussionPoster and/or Oral PresentationNot applicable Do you live within 25 miles of the Westin Buckhead Atlanta hotel?YesNo 2023 PeDRA Annual Conference Travel Scholarship Application Please provide a statement of interest describing your reason for wanting to attend the 2023 PeDRA Annual Conference and how a 2023 Travel Scholarship will help you attend (250-word maximum). Please provide the name and email address of a mentor, supervisor, or other clinician and/or researcher who can serve as a professional and/or academic reference, should PeDRA choose to contact them: Reference first name: Reference last name: Reference position: Reference institution: Reference email address: Please upload your CV or NIH-style biosketch in pdf format: Are you expecting to be an author or collaborator on any research being presented or discussed at the conference? Please select all that apply:NextGen Research ForumBreakout Session Project DiscussionPoster and/or Oral PresentationNot applicable Do you live within 25 miles of the Westin Buckhead Atlanta hotel?YesNo Contact Information Return to Conference Overview