Clinical Health Professional Research Travel Award

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Applicant Information (must be full time or part time employees of HHS) Page 1 of 2

Are you an HHS Employee? Yes HHS Employee ID#
Name: / Email:
Professional Credentials
RN C.Psych OT PT SW RPh RD RT SLP Other:
Research Training Credentials
Master’s degree: Doctorate degree: Other:
HHS Program/Service:
Hospital Site:
Location/Room:

Administrative Sponsor (HHS Program Director or Manager)

Name: Email:
HHS Program:

Conference Information/Details

Name:
Location: CITY PROVINCE/STATE COUNTRY
Date(s): from to
Is your abstract based on work supported by a grant or other financial award? Yes No
If Yes, please provide details of:
Funding Source: Amount of Funding Received:

Estimated Travel Expenses (original receipts required to process payments)

Estimated Expense Details (Please provide estimates of your expenses below) / Estimated Budget
Travel (air, rail auto/taxi etc) / $
Accommodation (hotel/lodging) / $
Meals (alcohol not eligible) / $
Conference Registration Fees / $
Other (specify): / $
TOTAL ESIMATED TRAVEL BUDGET REQUESTED / $

Checklist of Documentation to Accompany the Application Form

1.  Executive Summary (1-2 pages)
2.  Personal Summary (250 words)
3.  Appendices:
·  Abstract
·  Letter of Acceptance to Present at Conference
·  Letters of Support Clinical Manager
·  Letter of Support from Site-based Chief of Inter-Professional Practice /

Please check off

Date of Application (DD/MM/YY):


Date and Sign the bottom of this form and include with PDF submission Page 2 of 2

OUTLINE OF ALLOWABLE EXPENSES FOR THE HHS HEALTH PROFESSIONAL TRAVEL AWARD

Maximum $2500 (national conference) or $3500 (international conference)

Note 1: All reimbursements should be in compliance with the relevant HHS policies found on the Policy and Document Library on the HHS Intranet:

FIN & INFO – Travel Policy

FIN & INFO – Expense Reimbursement Policy

Note 2: Expenses will only be reimbursed for dates that include one day prior to and one day after the conference you are attending.

Note 3: A certificate of attendance must accompany the expense claim form; failure to submit this certificate

will result in non-payment of the expenses. (Note: this certificate is usually found on the conference website and can be printed for your expense submission)

Note 4: Only original itemized receipts are allowed, accompanied by credit card statement if paid by credit.

Note 5: Charges for alcohol will NOT be reimbursed.

Note 6: Failure to submit boarding passes with your expense claim could result in long delays in payment of

your reimbursement.

Note 7: You are required to submit a copy of your credit card statement for anything that is paid for by credit

card (showing that the item was applied to your account and the exchange rate charged if applicable).

All expenses including conference registration, air travel and hotel bookings should be made directly by the traveller and will be reimbursed upon completion of the trip.

Travel to/from home to local airport will be reimbursed to a maximum of $80.00 (one-way) if using a transportation service. Car travel will be reimbursed at 0.44 per kilometre to a maximum of 70 kilometres one-way. Airport parking expenses will be reimbursed.

Beginning with the day of departure and through to return home, all travellers will be reimbursed for meal expenses based on the maximum daily amount of $50 with the break down per meal set out in Appendix B of the FIN & INFO Travel Policy. Additionally, all original itemized receipts must be submitted for meal expense reimbursements; alcohol charges are not allowed.

Taxi fare to/from the airport in the city that is hosting the conference will be reimbursed, but only if an individualized, original receipt is provided.

Not Allowable Expenses:

You will not be reimbursed for hotel incidental charges (i.e. Internet/computer access, alcohol, mini-bar etc.).

Important Notice:

The cost of cancellation insurance will not be reimbursed. However, if you cancel your trip for medical reasons directly or indirectly related to the traveler (i.e., serious illness, accident or death of an immediate family member) HHS may reimburse the cost of the flight pending approval of the account signatory on a discretionary basis. Please note that HHS will not cover the cost of your flight for any non-urgent medical reasons. If you cancel your trip for any reason other than these types of examples, you must agree to reimburse HHS/McMaster University for expenses incurred for your flight. I agree to these terms:

Signed: ______Dated: ______