HSR Conference Travel Funding Application Health Services Research, Public Health, PhD Please complete this form if you are requesting additional funding for conference travel expenses. Name(Required) UF Email Address(Required) Senior Faculty Co-Author(Required) Abstract Title(Required) Other Authors On The Abstract(Required) Conference To Be Attended(Required) Location of Conference (City, State)(Required) Type of Presentation (e.g., poster, talk, paper)(Required) Brief Summary of Research To Be Presented(Required)Have you requested funding from the Graduate Student Council?(Required) Yes No If yes, please outline if your request was approved or denied. If approved what was the total you were approved for? Line item details of amount of travel funds being requested (maximum $700)Travel CostsAirfareConference RegistrationLodgingTransportation (e.g., to/from airport and hotel)Meals (max. per diem)Other (Describe below) Add RemovePlease complete the following to outline a detailed breakdown of your funding request. Description of Other